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� � <br /> A <br /> Statement of Organization � � - � <br /> � � <br /> Recipient Committee • - <br /> INSTRUCTIONS ON REVERSE <br /> Page 2 <br /> COMMITTEE NAME I.O.NUMBER <br /> C o�� ��v-� 1 r e 2 T'cs �1 C�.c�-r F��n i�- S ci�nr, ; d "r -�o r 'R e d w c=c°c� C i-r�j C��.,c��t <br /> Zv,3 <br /> • All committees must list the financial institution where the campaign bank account is located. <br /> NAME OF FINANCIAL INSTITUTION AREA CDDE/PHONE BANK ACCDUNT NUMBER <br /> U t�• -r e.d ��t,�. � '�a��t �5 v . L.� � � � � � � 0 tf y�tl I 1 i �3 <br /> ADDRE55 CITY STATE ZIP CODE <br /> 2-�I�n j�j ;-�c.dw a�/ '�t-c-�.e; Su 1 -re. IUC� �ec�wc�ci t-r�% � C A -r`l y o �,.3 <br /> 4.Type of Committee Complete the applicable sections. <br /> , �. •. . � <br /> • List the name of each controlling officeholder,candidate,or state measure proponent. If candidate or officeho►der 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"nonpartisan:' <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 GANDIOATEJOfFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABIEj YEAR OF ELECTION PARTV <br /> �Nonpartisan <br /> I— ✓n t � � C��v�n � C�'�' 2 � e cl C 1 r` Cr a�: G`, � Z t% i .� <br /> ❑ Nonpartisan <br /> • • •� • Primarily formed to support or oppose specific candidates or measures in a single e{ection. List below: <br /> CANOIDATE�S)NAME OR MEASURE(S)fULL TITLE(INCLUDE BALLOT N0.OR LETTER) CAND7DATE�S)OFFICE SOUGNT OR HELD OR MEASURE(5)JURISDICTION <br /> (INCLUDE DISTRICT NO.,qTY OR COUNTY,AS APPLICABLE) cHeCK OwE <br /> SUPPORT OPPOSE <br /> ❑ � <br /> SU�T O� <br /> FPPC Form 410(Dec/2012) <br /> FPPC Advice:advice@fppc.ca.gov(866/2753772) <br /> www.fppc.ca.gov <br />