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Form 410 - 2007 AmendmentStatement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or — I I Date qualified as committee 1. Committee Information NAME OF COMMITTEE STREET ADDRESS (NO P.O. BOX) Type or print in ink Amendment ist I.D, number: r _S0�[J —2 Z 1 Date qualified as committee (If applicable) qq qo Ocu)_ 04 CITY STATE ZIP C MAILING AbDRESSi(IF DIFFERENT) OPTIONAL: FAX/ E -MAIL ADDRESS COUNTY OF Datir ti-mp 171 Termination —See Part 5 12 List I.D. number:T.;. i Date of Termination STATEMENT OF ORGANIZATION Only 2. Treasurer and Other Principal Officers NAME OF TREASURER T STREET ADDRE (NO P.O. BOX) - CITY STATE ZIP CODE AREA CODE/PHONE AA-R�EACODE /PHONE v STREET ADDRESS.O. BOX)) CITY STATE ' ZIP CODE AREA CODE/PHONE Z' 6 0/-7-/ COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE Attach additional information on appropriately labeled continuation sheets. OF PRINC STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 3. Verification 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 penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on By DAT Executed on '2- -- .Z - By DATE Executed on DATE Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (June/09) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275 -3772) Statement of Organization Recipient Committee STATEMENT OF ORGANIZATION INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER /9,47' : >l' /C,e7i_ s=P�>z (;�Tc� ��1Cr/�/C /L.���1 / �2 6& 4. Type of Committee Complete the applicable sections. • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "non- partisan." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. ELECTIVE OFFICE SOUGHT OR HELD NAME OF CANDIDATE /OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY `/?t1�" ( YAon-Partisan J` m .�� 42)y tom( ❑ Non- Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION I AREA CODE /PHONE 1BANKACC ADDRESS CITY STATE ZIP CODE Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE SUPPORT JOPPOSE OPPOSE FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or Date qualified as committee 1. Committee Information NAME OF COMMITTEE Cc, Uc lkc_` for C� (1440 C- Q A �I i CITY n MAILING ADDRESS (IF D Type or print in ink J6 Amendment /List I.D. number: oS I,&L 2 7 Date qualified as committee (If applicable) ❑ Termination — See Part 5 in List I.D. number: # II Date of Termination 010uN c -► L PZ) I I').— STATE ZIP COD AREA CODE /PHONE OPTIONAL: FAX/ E -MAIL ADDRESS )q-0 L_ . C owl COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE Attach additional information on appropriately labeled continuation sheets. Date Stamp :CEIVED ANO FILI office of the Secretary of A of the State C xi;rcrnia JUL 0 9 2012 DEBRA BOWEN Treasurer and Other Princ 3.cSL ---0'= ADDRESS (NO P.O. BOX) STATEMENT OF ORGANIZATION For Off),cial use unly e t C-ft ANY I L 03 "e L(- - 1 V$ o4,. -'5SS�3 4c) CI STATE ZIP CODE AREACODE/PHONE r t ray C' QSDaQ qVJ6_ VES 3gV NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE 3. Verification 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 penalty of perjury under the laws of the State of California that the foregoing is true ar Executed on G "� / ''Z� By DATE Executed on By DATE Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) STATEMENT OF ORGANIZATION Statement of Organization CALIFORNIA ReOpient Committee .- INSTRUCTIONS ON REVERSE Page 2 I.D. NUMBER COMMITTEE NAME ^ -r.- �-- -, � , � i n r� . , . t F-, I C7- 1 S b 4. Type of Committee Complete the applicable sections. • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "non - partisan." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. ELECTIVE OFFICE SOUGHT OR HELD YEAR OF ELECTION PARTY NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) TR-�l It C-7 t _t t troy C� ci • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) ❑ Non - Partisan NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE UAW, AI:000IV i rvumoci, San- h� 6a �: t l�irusf 408 g�8� b © 4 5 b l CITY STATE ZIP CODE ADDRESS Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. 0 R LETTER) (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE FPPC Form 410 (June /08) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)