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Statement of Organization STATEMENTOFORGANIZATION <br /> Recipient Committee . - � , ' <br /> . - <br /> INSTRUCTIONS ON REVERSE <br /> Page 2 <br /> COMMITTEE NAME I.D.NUMBER <br /> sarv� ���- U 12�3 . <br /> 4.Type of Committee Complete the applicable sections. <br /> • List the name of each controlling officeholder, candidate, or state measure proponent If candidate or officeholder controlled, also list the elective office sought or held. and <br /> . district number, if any, and the year of the election. <br /> • List the political party with which each officeholder or candidate is affiliated or check"non-partisan." <br /> • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlied committee. <br /> NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD <br /> QNCLl1�E DISTRICT NUMBER IF APPUCABLE) YEAR OF ELECTION PARTV <br /> ,�NOn-Par�isan <br /> ��ar�we �uS � G � ( ea��v G'� ?UIl <br /> n /� / ,�Non-Partisan <br /> I�oSan✓� F �D�� L,�l� � un � � a-UD <br /> • List the financial institution where the campaign bank account is located (controlled"candidate election" committees only) <br /> NAME OF FINANCIALINSTITUTION AREACODE/PHONE BANKACGOUNTNUMBER <br /> w��1� �.��� �av� `L �-s�o - �y,� - yy3� (�a 2�v l <br /> ADORE55 CITY STATE ZIPCO�E <br /> 5 ov ���e�tl.�r�� !�I �� . (�.�vYO�,r� ��� � Gt� 9�101o� <br /> Primarily formed to support or oppose specific candidates or measures in a single election. List below: � <br /> CANDI�ATE(5)NAME OR MEASURE(S)FULL TITLE(INC W DE BALLOT NO.OR LETTER) CANDIDATE(5)OFFlCE SOUGHT OR HELD OR MEASURE(5)JURISDICTION ' <br /> (INCWDEDISTRICTNO.,CITYORCOUNTY,ASAPPLICABLE) CnECKONE <br /> SUPPORT OPPOSE <br /> Sl1PPORT OPPOSE <br /> FPPC Form 410 (April/2011) <br /> � FPPC 7oll-Free Helpline: 866/ASK-FPPC (866/2753772) <br />