Schmidt 03-20-2013 Initial State 410

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� � s M Statement of Organization . � - . ' Recipient Committee � - � INSTRUCTIONS ON REVERSE Page 3 COMM�iTEE NAME I.p.NUMBER C OvY1v�i T�-C. 'Tc� �12cT � r'r� i � �'-,' G�1YY�i "f' �c! �(Zec�W�e t�'T �� c,.�C� � I.OI 4.Type of Cammittee (Continued) ' � ' •• • • Not formed to support or oppose specific candidates or measures in a single etection. Check only one box: ❑ CITY Committee ❑ COUNTY Committee❑ STATE Committee PflOViDE BRIEF OESCRIPTION OF ACTIVITY , �� • •• • �� •• list additional sponsors on an attachment. NAME Of SPONSOR INDUSTRY GftOUP OR AfFILIATION OF SPONSOR STREETAODRE55 NO.ANDSTREET CIN STATE ZIPCODE � � r • � � 1 / Date qualified 5.Termination Requirements By signing the verification,the treasurer,assistant treasurer and/or tandidate,officeholder,or proponent certify that all of the following conditions have been met: • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge atl debts,loans received,and other obligations; • This committee has no surplus funds;and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. -- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. -- Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511-89518,and aie subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410(Dec/1012) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov