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Statement of Organization STATEMENT OF ORGANIZATION <br /> Recipient Committee CALIFORNIA 410 <br /> INSTRUCTIONS ON REVERSE <br /> Page 2 <br /> COMMITTEE NAME ------ <br /> I.D.NUMBER <br /> %,..)01+11,I 1/403 ti-72 <br /> T <br /> 4.Type of Committee Complete the applicable sections. <br /> Controlled Committee <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 controlled committee. <br /> NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD <br /> (INCLUUDDCTIVE(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY <br /> -TO W\1 `S* Non-Partisan <br /> fl Non-Partisan <br /> • List the financial institution where the campaign bank account is located(controlled"candidate election"committees only) <br /> NAME OF FINANCIAL INSTITUTION ARpA CODE/PHONE BANK ACCOUNT NUMBER <br /> %Tel) Ameri cA-IN) )2_tig ---70z5e?, 04-0 0 t! <br /> ADDRESS C TY STATE ZIP CODE <br /> 2 14 ce (3ea AINJA4 k bo clq061 <br /> Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: <br /> CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION <br /> (INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE <br /> SUPPORT OPPOSE <br /> SUPPORT OPPOSE <br /> FPPC Form 410 (January/05) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) <br />