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�'� � <br /> , ' w �:, � �— <br /> � ���� ��� <br /> Statement of Organization REC�I��� ��� � - • <br /> Recipient Committee in the office of the�e <br /> Statement Type �f thQ State of ± <br /> �(nitial ❑ Amendment ❑ Termination—See Part 5 i r e� s i �� <br /> Not yet qualified� or List I.D.number. List I.D,number. H P R 2 � Q I <br /> � # i�EBRA � �� MAY 0 6 2013 <br /> —.—/ / / / / / �eCf e'�al"11 ����oF r��a��vo��cir� <br /> Da1e qualified as committee Date qualified as committee Date of Termination <br /> pfapplicable� CITY CLERK <br /> 1. Committee Information 2. Treasurer and Other Principal Officers <br /> NAME OF COMMITTEE ���.^`� ;.��� .�� �i�.�_ ���; � ������(;���° NAME OF TREASURER <br /> �c� �2QC���c�cl C ,-r� c.c�v.�c ;� °Zci t � �e..c�-:�+na � . . cx,3 �.� <br /> STREET ADDRE55(NO P.O.BOX) STREET ADOftESS(NO P.O.BOXJ <br /> <br /> . .�'ZectUV�c�{ �,r�J� c�► 9'�c�L ������ L��J, �'.� 9ycE�L <br /> STATE ZIP CODE AREA CODE/PNONE CITY $TATE ZIP CODE AREA CODE/PHONE <br /> �sG •4�5ty��� ��,��.��'• � <br /> MAILING AOpRE55�IF OIFFERENTI NAME OF ASSISTANT TREASURER,IF ANY <br /> FAX/EMAILqODftE55 � <br /> STREETAp�flE55(NO P.0,80X) <br /> COUNTY OF DOMICIIE JURISDICTION WHERE COMMITTEE IS ACTIVE CITY STATE ZIP CODE AREA CODE/PHONE <br /> NAME OF PRINC�PAL OFFICER(5) <br /> Attach additional information on appropriately labe(ed continuafion sheets. sraEer aooaESS ir,o P o.aoxt <br /> C�T� STATE ZIP CO�F AREA CODE/PHONE <br /> 3. Veri cation <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 <br /> penalty of perjury under the laws of the State of California that the foregoing is true and correct. <br /> .; • <br /> Executed on ` ' � t?f gV �r`�-�`�c`L�_ t�''k���R.:a <br /> DATE SICiNATURE OF TREASURER OR ASSISTANT TREASURER <br /> �i'� £,. . <br /> t�� . {� ° �� � � '`" `" <br /> Executed on � BY ��„_ ,�._,,,�� , � ��'��� <br /> DA7E <br /> SIGNATURE OF CONTNOLIING OFFICEHOIDER,CANDIDATE,Oft STATE MEASURE PROPONENT <br /> Executed on By <br /> DA7E SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OA STATE MEASURE PROPONENT <br /> Executed on gY <br /> DATE SIGNATURE OF CONTROLLING OPfICEHOLDEft,CANDIDATE,OR STATE M[ASURE PROPONENT <br /> FPPC Form 430(Dec/2012) <br /> fPPC Advice:advice@fppc.ca.gov(866/275-3772) <br /> www.fppc.ca.gov <br />