Laserfiche WebLink
Statement of Organization <br /> Recipient Committee <br /> Amendment <br /> �Check box if an AmerWment <br /> and enter I.D.number: <br /> p �U c�J %�� <br /> INSTRUC710NSONREVERSE <br /> 1. <br /> File original and ons eopy with: <br /> Secretary of State <br /> Political Retorm Division <br /> P.O.Box 1467 <br /> Sacramento,CA 95812-1467 <br /> County end City Committee� (ile a eopy with: <br /> Lxal filing oflicer who will receive the original <br /> disclosure statements. <br /> Type or print in ink <br /> Date qualified az commitlee�J�� �Not yet qualified <br /> NAMEOFCAA�IITTEE <br /> C� ���,� �tf-ee �lec� <br /> ���--hcz-c�-c` r,e.�-c� <br /> ADDRESSOFCOMMITTEE NO.ANDSTREET(NOP.O.BOX) <br /> � �l� <br /> S�� ����.� <br /> ) -�'' <br /> STATE ZIPCODE <br /> �' l�l �l y U (�� <br /> COUNiY OF DOMICAE <br /> CRV SWTE LPCOOE ARFACODFiPHONENUMBER <br /> OPfpNAL• AREACAOFJFAXNUMBER OPTpNAL: E-MAILADDRESS <br /> <br /> 2. <br /> and Other <br /> <br /> <br /> <br /> <br /> �� <br /> AREACODHDAVTIME PHONE <br /> NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S),IF APPLICABLE <br /> MAILING ADDRESS <br /> / ,}--� �/ <br /> <br /> 3. Verification <br /> i have used all reasonable diligence in preparing this statement and to the best o nowledge the information contained herein is.true and complete. i certify <br /> under penalty of peryury under the laws of the State of Califomia that the forego' ' t and correct. <br /> Exe��t� �, �— ` - 9 9 aY .---� <br /> -7 /- CDA pE /�, SICaNAiUREOF EASURER <br /> Ezecuted on / — �G' ` / ! By �� , 1� 1Q�l G" � O R �t <br /> SIGNATUAE OF CONTROLLING OFFICEMOlOER,CANDIDAiE,OR 5T/TE MEASURE PROPONEM <br /> Executed on <br /> DATE <br /> BY <br /> SIGNRURE OF CONTROILINOOFFICEHOLDER,CAN010�7E.OR STA7E MEASUPE PROPONEM <br /> Executed on By <br /> DA7E SIGNATURE OF CONTROLLING OFFICEHOLDER,CANOIDATE.OR STA7E MEASURE PROPONEIR <br /> INFORMRTIONREWIRED70BEPROVIDEDiOMWPURSUANTTOTIEINFORAU710NPiUCTCESACTOF1977,5EE 4 'PM NOI ^ O� FROVI ION OF R �VICT. <br /> FPPC Form 110 (2/98) <br /> For Tachnleal Asslstenee: 916/322-5660 <br />