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, .‘.\\ <br /> F <br /> l <br /> Statement of Organization \---) \-- C\\0. STATEMENT OF ORGANIZATION <br /> Type or print in ink <br /> Recipient Committee Date Stamp <br /> eclple ttee CALIFORNIA <br /> FORM 410 <br /> Statement Typenitial ❑ Amendment ❑ Termination–See Part 5 For Official Use Only <br /> List I.D. number: List I.D. number: F `� ° x " -'R , <br /> Not yet qualified ❑ or <br /> _ , <br /> in the office Of th . 3ec.�'o-tery Of St 's - <br /> 6 .� <br /> # #— of the State of California 6 i <br /> L eZ I .- . L) ' _—.__.�___, ________1______I DEC 0 4 r <br /> 2008 <br /> Date qualified as committee Date qualified as committee Date of Termination , _,, <br /> (If applicable) <br /> 1. Committee Information 2. Treasurer and Ott.- 4.094314 r f fib <br /> NAME OF COMMITTEE NAME OF TREASU R <br /> C- c .1 <br /> SE\i STREET ADDRESS <br /> - <br /> STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP COD AREA CODE/PHONE <br /> � c-i city C A i`�- �t.j 2 �,/ <br /> CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY <br /> A'eA.,1/4)1:v),0 <br /> Cri-y C - !'tJO ; ( " <br /> STREET ADDRESS <br /> MAILING ADDRESS(IF DIFFERENT) e r/ 4191 :2—CITY STATE ZIP CODE AREA CODE/PHONE <br /> OPTIONAL: <br /> <br /> _ . NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S),IF APPLICABLE <br /> COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT <br /> THAN COUNTY OF DOMICILE <br /> S A MAILING ADDRESS <br /> CITY STATE ZIP CODE AREA CODE/PHONE <br /> Attach additional information on appropriately labeled continuation sheets. <br /> 3. Verification <br /> I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of <br /> perjury under the laws of the State of California that the foregoing is true and correct. <br /> Executed on /2/3�`o By % ,r_x'' . 'fir Z:Zeie <br /> SIB. 'T ' EOFTO' ' •R ASSISTANT TREASURER <br /> Executed on <br /> z/ /ATE <br /> gy .---- A 4 ATE .ti. SIGNATU-E OF CONT',LL'G•'4 IC;HOLDER,CANDIDATE,OR STATE MEASURE PROPONENT <br /> Executed on By <br /> DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT <br /> Executed on By <br /> DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT <br /> FPPC Form 410 (January/05) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC (866/275,3772) <br />