HomeMy WebLinkAboutForm 410 - 2007 InitialStatement of Organization Type or print In Ink
4 �
Recipient Committee
Statement Type .Initial ❑ Amendment
Not yet qualified ❑ or List I.D. number:
❑ Termination — See Part 5
List I.D. number:
Date qualified as committee Date qualified as committee Date of Termination
(If applicable)
1. Committee Information
NAME OF COMMITTEE
C.74-21,'S 4,e Wdedwa<ec'
STREET ADDRESS (NO P.O. BOX)
7ay/ E,,1� 12•d�� ��
CITY STATE ZIP CODE AREA CODEIPHONE
G -/goy Cq' 7razo dog- ggI! -92�
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX I E-MAIL ADDRESS
nwoodw4fdcs>? .�Errq — /aw. cc.vt
COUNTY OF DOMICILE (COUNTY WHERE COMMITTEE iS ACTIVE IF DIFI -hKtNI
THAN COUNTY OF DOMICILE
54.x- Gla ✓a
Attach additional information on appropriately labeled continuation sheets.
2.
Date Stamp
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I v i r7
1. I
STATEMENT OF ORGANIZATION
AUG 2 4 2007
REGISTRAR OF VOTERS
: OUNTY OF SANTA CLARA
Treasurer and Other Principal Officer LeN"`)
NAME OF TREASURER
104A a/ 6.of
STREET ADDRESS
756 Lt:lO.� ��,.+
CITY STATE ZIP CODE AREA CODEIPHONE
(fA 41 So2a yo$- gY2-9o33
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS
CITY STATE ZIP CODE AREA CODEIPHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODEIPHONE
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the inf
perjury under the laws of the Sat of California that the foregoing is true and correct. 44111k
Executed on g7 O By
DATE
Executed on 5/�—/07
DATE / '� StOWURE OF
Executed on
Executed on
DATE
contained herein is true and complete. I Certify under penalty of
MEASURE
T B
C fy, y SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (January/06)
FPPC Toll -Free Helpline: 8661ASK -FPPC (8661276 -3772)
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FPPC Form 410 (January/06)
FPPC Toll -Free Helpline: 8661ASK -FPPC (8661276 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
4. Type of Committee Complete the applicable sections.
OF
• 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/OFFICEHOLDERISTATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE)
Non - Partisan
✓� .� . iit%odula n.� /tAc...Lc /� C�iGr C. t�ovvG.'/ Z ob %
Non - Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION
W,_115 faigo jjQ, A. I ,l. A•
AREA CODE/PHONE
BANK ACCOUNT NUMBER
3572-7 --73877
ADDRESS r CITY STATE ZIP CODE
12,( /�. ✓,(C C� P101 2-4- , r s f /e.,� S ti Jo
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
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
ONE
FPPC Form 410 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
C.-k2c -s -fov "dja.d
4. Type of Committee (Continued)
Gerieral Purpose Cotrmjittee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
NAME OF SPONSOR
STREET ADDRESS NO. AND STREET
GROUP OR AFFILIATION OF SPONSOR
ur, LIU=
.D. NUMBER
Pt
ORGANIZATION
• ' • ❑ _J__/ Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a
Date qualified small contributor committee on January 1, 2001, enter 1/1101.
5. Term i nation Requirements By signing the verification, the treasurer, assistant treasurer and /or candidate, officeholder, or proponent certify that all of the following conditions have been met:
• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
• This committee has no surplus funds; and
• This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
-- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to
Government Code Section 89519.
FPPC Form 410 (January/06)
FPPC Toll -Free Helpline: 8661ASK -FPPC (8661276 -3772)