Roland Velasco - Form 410 - 2017 Amendment (2)Statement of Organization
Recipient Committee
Statement Type ❑ Initial Amendment
Q Not yet qualified
or
O Date qualified as committee
Date qualified as committee
(If amending to provide this date)
i
❑ Termination — See Part 5
Date of termination
Date Sta
of�faat�ef- �I�f�t'nia
For OrtiaM n0nlyto,��
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NAME OF COMMITTEE NAME OF TREASURER
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STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS (NO P.O, BOX) CITY STATE ZIP CODE AREA CODE /PHONE
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CITY V STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREA_ URER, IF ANY
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MAILING ADDRESS (IF DI ERENT) STREET ADDRESS (NO P.O. BOX)
E -MAIL ADDRESS (REQUIRED) / FAX (OPTTIIO�NALL)� ,�` � � /��"/ � / � �/� CITY STATE ZIP CODE AREA CODE/PHONE
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COUNTY OF DOMICILE JURISDICTIO WHERE COM TEE IS CT VE NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
Attach additional information on appropriately labeled continuation sheets.
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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
CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE 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 (May /2017)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
I LED
rNa
Page 2 '
I D NUMBER
.f v
ZIP CODE
q3b �]� W
Controlled Committee
• 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 "nonpartisan"
• 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
`Statement of Organ 'zation
onpartlsan
y Recipie nt Committees f-
INSTRUCTIONS ON REVERSE
❑ Nonpartisan
3 ire
OPPOSE
-�d n
COMMITTEE NAME
2620
❑
❑
i All�eo rnmitteds r uyst�fist the financial institution where the campaign, bank account Is located. v
C'
NAME OF FINANCIAL INSTITUTION
f+4c
AREA CODE /PHONE
BANK ACCOUNT NUMBER
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ADDRESS
fa
CITY _ STATE
Page 2 '
I D NUMBER
.f v
ZIP CODE
q3b �]� W
Controlled Committee
• 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 "nonpartisan"
• 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
Primarily Primarily formed to support or oppose specific candidates-or measures in a single election List below
JURISDICTION
CANDIDATE
CANDIDATES) NAME OR MEASURES) FULL TITLE (INCLUDE BALLOT NO OR LETTER) S) OFFICE SOUGHT OR HELD OR MEASURES) _
_ . (INCLUDE DISTRICT NO, CITY OR COUNTY, AS APPLICABLE) , I rwrric nmr
' ^
onpartlsan
SUPPORT
❑ Nonpartisan
Primarily Primarily formed to support or oppose specific candidates-or measures in a single election List below
JURISDICTION
CANDIDATE
CANDIDATES) NAME OR MEASURES) FULL TITLE (INCLUDE BALLOT NO OR LETTER) S) OFFICE SOUGHT OR HELD OR MEASURES) _
_ . (INCLUDE DISTRICT NO, CITY OR COUNTY, AS APPLICABLE) , I rwrric nmr
FPPC Form 410 (May /2017)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
LJ
SUPPORT
OPPOSE
❑
❑
FPPC Form 410 (May /2017)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov