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Statement of Organization <br />Y.... IIateStahp <br />CALIFORNIA <br />410 <br />Recipient CommitteeFORM <br />Statement Type ElInitial ElAmendment <br />❑ Termination — See Part 5 <br />For official use only <br />Not yet qualified El or List I.D. number: <br />List I,D. number: J p N ( n 4 <br />h1I 7 <br />20P <br />q <br /># 1376624 <br />t <br /># <br />12 31 2016 u <br />Date qualified as committee Date qualified as committee Date of Termination Q <br />(If applicable)-�• <br />1. Committee Information <br />2. Treasurer and Other Principal Officers <br />NAME OF COMMITTEE <br />NAME OF TREASURER <br />Shelly Masur for Redwood City Council 2015 <br />Shelly Masur <br />STREET ADDRESS (NO P.O. BOX) <br />440 Birch Street <br />STREET ADDRESS (NO P.O. BOX) <br />CITY <br />STATE <br />ZIP CODE AREA CODE/PHONE <br />440 Birch Street <br />Redwood City <br />CA <br />94062 (650)814-0349 <br />CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY <br />Redwood City CA 94062 (650)814-0349 N/A <br />MAILING ADDRESS (IF DIFFERENT) <br />STREET ADDRESS (NO P.O. BOX) <br />CITY <br />STATE <br />ZIP CODE AREA CODE/PHONE <br />FAX/E-MAIL ADDRESS <br />shelly@shellymasur.com <br />COUNTY OF DOMICILE <br />San Mateo <br />IURISDICTION WHERE COMMITTEE IS ACTIVE <br />(Redwood City <br />NAME OF PRINCIPAL OFFICER(S) <br />Shelly Masur <br />STREET ADDRESS (NO P.O. BOX) <br />440 Birch Street <br />CITY <br />STATE <br />ZIP CODE AREA CODE/PHONE <br />Attach additional information on appropriately labeled continuation sheets. Redwood City <br />CA <br />94062 (650)814-0349 <br />3. Verification <br />I have used all reasonable diligence in preparing this statement <br />and to the best of my knowledge the information contained herein <br />is true and complete. I certify under <br />penalty of perjury under the laws of the State of Califwi that <br />th f regoing is true and correct. <br />� � <br />Executed on By <br />�"� <br />TREASURER ORASSISTANT TREASURER <br />�7 <br />�1 L4 By <br />Executed <br />(jSIGNATUREOF <br />'l o <br />on <br />BATE <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />Executed on By <br />DATE <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />Executed on By <br />DATE <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />FPPC Form 410 (tan/2016) <br />FPPC Advice: advice@fppc.ca-gov (866/275-3772) <br />www.fppc.ca.gov <br />