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HomeMy WebLinkAboutForm 410 - Initial'Statement of Organization Recipient Committee Statement Type Initial Not yet qualified ❑ or Type or print in ink ❑ Amendment ❑ Termination - See Part 5 List I.D. number: List I.D. number: _05- I /:� I / ?I If _ 1I Date qualified as committee Date qualified as committee Date of Termination (If applicable) 1. Committee Information KI NAME OF COMMITTEE ^ STREET ADDRESS (NO P.O. BOX) �' 14 13 D o c- vi v ck C-t- CITY STATE ZIP CODE AREA CODE /PHONE (S' � _O y C1 95 -62-0 'b�1 9Y /-5— MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX/ E -MAIL ADDRESS 0SC£0LAM o(i) y, +/,moo. G~;a44-­ r` STATEMENT OF ORGANIZATION 2. Treasurer and Other Principal Officers NAME OF TREASURER 4 1, s /5�- 9 la S k STREET ADDRESS (NO P.O. BOX) " 79 Do rn o c,4. CT_ CITY STATE ZIP CODE AREA CODE /PHONE E OF ASSI STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT 4 414- C THAN COUNTY OF DOMICILE STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE /PHONE Attach additional information on appropriately labeled continuation sheets. Verification Fhave used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete F, erjury under the laws of the State of California that the foregoing is true and correct. Executed on D Tit Executed Executed on ]Z.,9 � / DATE Executed on DATE Executed on DATE I certify under penalty of 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 (866/275 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE STATEMENT OF ORGANIZATION Page 2 -A r y 1 y2 O 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 er J ✓ / " 7 d C Z Pf /"t Non Partisan ❑ Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER 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 OPPOSE FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) State -►it of Oirga`niiation Recipient Committee Statement Type Initial Not yet qualified ❑ or Type or print in ink ❑ Amendment ❑ Termination — See Part 5 List I.D. number: List I.D. number: Date qualified as committee Date qualified as committee (If applicable) 1. Committee Information NAME OF C�MMTTE /J / I STREET ADDRESS (NO P.O. BOX) 7- '4 13 DO c— 0 V � C� Date of Termination CITY STATE ZIP CODE AREA CODE /PHONE b� 1 9 Y/ .- MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX/ E- MAILADDRESS 0Sc (E C3L,/ M o(j� y/fG, ao_ co 44-,- COUNTY OF Gt DOMICILE I COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT n T . THAN COUNTY OF DOMICILE Attach additional information on appropriately labeled continuation sheets. Rejected: Retur _j' � ✓ _a'2 . fled: STATEMEN OF ORGANIZATION Date Stamp in he office o the SUVretary of �'t8the o {f1ee Fe�nly of the State of California „.of the Statr JUN 27 2012 DEBRA. BOWEN DEBRA BO�SecretarV Of Stat i/ 2. Treasurer and Other Principal Officers LI NAME OF TREASURER ,-- ,s /--ii- S' /as STREET ADDRESS (NO P.O. BOX) / �r �L/ �� �or�0c'kC CITY STATE ZIP CODE AREA CODE /PHONE G; 01- 9�t,2 NAME OF ASSISTANT TREASURER, IF ANY STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) STREETADDRESS (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 D TE Executed on ���� l IDATE 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 (866/275 -3772) Sf'atlhnenf of, Organization Recipient Committee INSTRUCTIONS ON REVERSE STATEMENT OF ORGANIZATION Page 2 COMMITTEE NAME I.D. NUMBER ll� �0�z - 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 F -_ 4- �� {7 re, 1 ` o i n 1 " L /� O it O � (7 I l � 0 � � /� Non-partisan ❑ 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 BANK ACCOUNT NUMBER E,�,p4a- /� d c,_ �. K �� &-9-S---Y,12&—:72Z9 0/(739 �t7- 71;�,' ti ADDRESS CITY STATE ZIP CODE ko 00 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 OPPOSE FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or Date qualified as committee Type or print in ink Amendment List I.D. number: -J� Date qualified as committee (If applicable) 1. Committee Information NAME OF COMMITTEE �v 3 ❑ Termination — See Part 5 List I.D. number: STATEMENT OF ORGANIZATION Date Stamp' MAY 2012 Date of Termination STREETADDRESS (NO P.O. BOX) 7 Dor- C4 C-- CITY STATE ZIP CODE AREA CODE /PHONE (7 i/"3/ 11 14 ?S -02_0 41A*R- 621-�Y, MAILING ADDRESS (rF DIFFERENT) OPTIONAL: FAX/ E -MAIL ADDRESS Os r- o/_ COUNTY OF DOMICILE � /J" +'A r alt © d w-e_ COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE Attach additional information on appropriately labeled continuation sheets. 2. Treasurer and Other Principal Officers NAME OF TREASURER STREETADDRESS (NO P.O. BOX) 7-y73t c - CITY > STATE ZIP CODE AREA CODE /PHONE 0s2 41 L9 9TO Z- 0 NAME OF ASSISTANT TREASURER, IF ANY STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE /PHONE 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 Executed on S/ Z J— / / L 11� DATE Executed on .4z r- /"I Z' E ATE 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 (April /2011) FPPC Toll -Free Helpline: 866 1ASK -FPPC (866/275 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME 4. Type of Committee Complete the applicable sections. STATEMENT OF ORGANIZATION I.D. NUMBER • 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 CAN MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY PPA F_ r- P 1- e— J . ( CAA Q M /I LI, 0 c., �2_ c) 2- o / z__ Non - Partisan ❑ Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANKACCOUNT NUMBER .E!24) ' a o 2- 2F OC v3 P 42� ADDRESS CITY STATE ZIP CODE o 0 0 q,A+4 Tt,,�e. (- A icy /v� (� till 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 )RT OPPOSE FPPC Form 410 (April /2011) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)