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STATEMENT OF ORGANIZATION <br /> Statement ofOrganization typ.or Prinl I. Ink. ~mendment J Dale Slamp <br /> Recipient Committee I I~.Check Ix, x iT an ^n,cndm¢,,, I <br /> J and eltler I.D. number: <br /> (government Code Sections 84101-84103) <br /> I <br /> / . .~ J[~ J~ ~ ~ 0 ~ ~ F..~.~!:'- -- -- -- A For Ollicial Uso Only <br /> <br /> SecreiaryofSlale thlsformwllh: JAN' b <br /> <br /> P.O. Box 1467 receives the commillee's original J <br /> SacramelllO, CA 95812-1467 carnpaign disclosure statements. -- <br /> <br />I Commillee Informalion II TreasurerandOlherPrincipaIOfficers <br /> NAME ~ COBMIIIEE: HAME OE 1RI:.ASU~ER <br /> <br /> ~tA-i'L ~G A~ESS~ (IF DIFFE~NT IH~ CO,MIl <br /> <br /> C?_Y) ' ' SIAIE ZIP C~E NAME~NO ~SI~ I~ ~ el t IER RtlNCIPAL'OFF ~S): ' ' <br /> <br /> ~K]Ng AD~: (IF DIFFE~NI) NO. A~ SteEl ~ P O ~X ~ILING A~: (IF DI~F[R~NI ltt~ <br /> <br /> C~ ~O~ ~SIAIE' ~~~IZiP C~E I AI~ R STALE ZIP CffiE A~ C~l~ IME PlaNE <br /> <br />III Controlled Commillee <br /> Is Ihis committee conffolled by ~ officeholder, c~didate, or stole m~sure pm~nenl? (See deflation and i~ortant i~or~tion on reverse.) <br /> ~ Yes (Complete Ihe following) ~ No <br /> · If this commitl~ is con~oll~ by ~ officeholder or a candidale, list ~e nme of ~e con~olling officeholder or c~didale, t~ elective office ~ught or hehl, and disffict <br /> numar, if any. if this committ~ is con~oll~ by more ~an one ~ndi~te, list Ihe n~e of tach con.oiling candidate. <br /> · If this commiu~ is conffoll~ by a state m~sure pm~nent, iisi the name of the stole m~sure pro~nent. If this cmmill~ is conuolled by more than one stole me.ute <br /> pro~nent, list the name of e~h state me.ute pro~nent. <br /> · if this commiU~ ac~ jointly with another con.oiled commill~, list the name ~d idenlificalion numar of Ihe other con.oiled committ~. <br /> <br /> Attach additional information on al)propriately labeled continuation sheets. <br /> You musl complele lhe Verificalion on Page 2. <br /> <br /> FOR INFORMATION REQUIRED I0 BE PROVIDED 10 YOU PURSUANT TO TI IE INFORMAIION PRACIlCES ACT OF 1971. SEE lkl[Q~lM~klLt~t <br /> <br /> Slate of Calilornla Fair Political Practices Commission <br /> <br /> <br />