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S STATEMENT OF ORGANIZATION <br /> Statement of Organization <br /> Recipient Committee CALIFORNIA 410 <br /> FORM <br /> INSTRUCTIONS ON REVERSE Page 2 <br /> COMMITTEE NAME I.D.NUMBER <br /> John Seybert for Redwood City Council-2009 1313963 <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 /> ELECTIVE OFFICE SOUGHT OR HELD <br /> NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY <br /> ® Non-Partisan <br /> John Seybert City Council 2009 <br /> ❑ Non-Partisan <br /> • List the financial institution where the campaign bank account is located(controlled"candidate election"committees only) <br /> NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER <br /> United American Bank 650-298-7000 041-002494 <br /> ADDRESS CITY STATE ZIP CODE <br /> 2400 Boradway#100 Redwood City CA 94063 <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(June/09) <br /> FPPC Toll-Free Helpline: 866/ASK-FPPC(866/275-3772) <br />