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Statement of Organization <br />Recipient Committee <br />Statement Type ❑ Initial ❑ Amendment <br />Q Not yet qualified <br />or <br />O Date qualification threshold met Date qualification threshold met <br />Date Stamp <br />R in Ee o <br />IIE JtucCd!J u: Jiu.c <br />Termination — See Part 5 of the State of California <br />FEB 01201, <br />Date of termination <br />01 29 2021 <br />1. Committee Information I.D. Number . �- 2. Treasurer and Other Principal Officers <br />(if applicable) I � ( S 1 <br />ME OF COMMITTEE NAME OF TREASURER <br />G-, �sr�-5'�W �Ct CQIt✓�C.�` Z' CindyGalisatus <br />STREET ADDRESS (NO P0, BOX) <br />518 Hillside Road <br />STREET ADDRESS (NO P.O. BOX) <br />518 Hillside Road <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />Redwood City CA 94062 (650) 521-1772 <br />FULL MAILING ADDRESS (IF DIFFERENT) <br />E-MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL) <br />jgalisatus@gmail.com <br />COUNIY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE <br />San Mateo Redwood City <br />Attach additional information on appropriately labeled continuation sheets. <br />MAR 2 9 2021 <br />CITY OF REDWOOD CITY <br />CITY CLEW <br />CITY <br />Redwood City <br />STATE <br />CA <br />ZIP CODE <br />94062 <br />AREACODE/PHONE <br />(650) 780-0255 <br />NAME OF ASSISTANT TREASURER, IF ANY <br />STREET ADDRESS (NO P.O. BOX) <br />CITY <br />STATE <br />ZIP CODE <br />AREA CODE/PIIONE <br />NAME OF PRINCIPAL OPHCER(S) <br />STREET ADDRESS (NO PO. BOX) <br />CITY <br />STATE <br />ZIP CODE <br />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 alif An','t4at,!*foregoing is true and correct. <br />Executed on 01/29/2021 By <br />DAIE SIGNATURE OF TREASURER OR ASSISTANT TREASURER <br />Executed on 01/29/2021 By, <br />DATE <br />Executed on <br />DATE <br />Executed on <br />DATE <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />By <br />l SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />By <br />SIGNATURE OF CON I ROLI ING OFFICEHOLDER, CANDIDAI F, OR S IAfE MEASURE PROPONEN I <br />FPPC Form 410 (August/2018) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />