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Statement of Organization <br />F. <br />Recipient Committee <br />- <br />Statement Type ® Initial ❑ Amendment ❑ Termination — Seep 5L-'YUo.R- <br />� 3 2020 <br />For Of dal Use only <br />Not yet qualified <br />or <br />f dwood City <br />O Date qualification threshold met Date qualification threshold met <br />Date of terminatlonity <br />Clerk <br />Committee1. I.D. OM -M <br />2. Treasurer and Other <br />�n IrGokrc <br />NAME OF COMMiTTiE <br />NAME OF TREASURER <br />al 7r eV&'*eai< <br />STRE E T AD D RES S(NO P.O. BDXI <br />-7 C r s <br />aiO 7;P- <br />STR EET AOA R E 55( NO P.O. BOX I <br />CITU <br />5TATF <br />CoDF AREACODFARONEE <br />?W 2FdX7-1e—&QWZ g <br />A71P <br />Y 'G <br />CITY �%� STATE ZIP CODE ,7�jC D�E(PF� <br />�J <br />NAME OF ASSISTANT TREASURER, IF A <br />zkm to 00Z i� <br />FULL MAILING ADDRESS (IF DIFFERENTV <br />STREET ADDRES5 (NO P.O. BOX <br />E•MAII. ADDRESS (REQUIRED) I tM(MPTIONALI <br />CITY <br />STATE <br />ZIP CODE AR EA CO D EIPH ONE <br />COONTY ❑ DO NTICItF <br />)UMSDICTION WHERE COMMITTEE 15 ACTIVE <br />NAME OF PR INC I PAL OFF 51 <br />STR EET AO D PEON P.O. BOX} <br />000, <br />%QYr1 <br />Attach additional information on appropriately labeled continuation sheets. <br />CITY <br />STATE <br />21P CODE AREA CODE/PHONE <br />3. Verification <br />I have used a reasonable di igence in preparing <br />penalty of peri ur u der th �aws ❑f he State of <br />Executed on 4 , 0 By <br />nnT <br />Executed on <br />Executed on <br />Executed on <br />By <br />DATE <br />DATE By <br />DATE <br />ent and to th st of y know a ge the information contained herein is true and complete. Icert y under <br />hwit the f❑reR� iWie and correct. <br />CONTROLLING 0FIiICFtMER, CANOIDAT E,0R STATE MEASURE PROPONENT <br />SIGNATURE OF CONT ROLLI NG OF F ICEHO LD ER. CANDIDATE, OR STATE MEASURE PROPONENT <br />By <br />SIGNATURE OF CONTROLLING OFF IC E I IOL DE R. CAN OI DAT E, OR STATE MEASURE PROPONENT <br />FPPC Form 410 (August/2018) <br />FPPC Advice: ad_vice�f 77pc.sp .a.ro%(866/275-3772) <br />www.fppc.ca.gov <br />