HomeMy WebLinkAbout2011 - Form 410 Termination
STATEMENT OF ORGANIZATION
Date Stamp
~ Termination - See Part 5
List 1.0. number:
Type or print in ink
o Amendment
List I.D. number:
Statement of Organization
Recipient Committee
o Initial
Not yet qualified
Statement Type
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Date of Termination
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Date qualified as committee
(If applicable)
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Date qualified as committee
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Treasurer and Other
NAME OF TREASURER
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Committee Information
NAME OF COMMITTEE
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AREA CODEIPHONE
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ZIP CODE
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STREET ADDj<ESS
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CITY
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MAILING ADDRESS (IF DIFFERENT
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OPTIONAL: FAX I E-MAIL ADDRESS
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COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
IF ANY
AREA CODEIPHONE NAME OF ASSISTANT TREASURER,
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STREET ADDRESS (NO P.O. BOX
ZIP CODE
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STATE
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AREA CODEIPHONE
ZIP CODE
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NAME OF PRINCIPAL OFFICER(S)
CITY
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AREA CODEIPHONE
ZIP CODE
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certify under penalty of
my knowledge the information contained herein is true and complete
By
By
Attach additional information on appropriately labeled continuation sheets.
Verification
I have used all reasonable diligence in preparing this statement and
perjury under the laws of the State of California that the foregoing is
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'i.-I:t\ \
Executed on
3
OR STATE MEASURE PROPONENT
Executed on
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (June/09)
866/ASK-FPPC (866/275-3772)
FPPC Toll-Free Helpline:
By
By
DATE
DATE
Executed on
Executed on
Statement of Organization
Recipient Committee
Termination - See Part 5
D. number
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#
O~ I L~ I '2,0 ~ l
Date of Termination
l<b"2-8 CUl4
Type or print in ink
_ L
Date yualliiea as committee
(If applicable)
o Amendment
List ID, number;
#
or
I I
Date qualified as committee
o
o Initial
Not yet qualified
Type
Statement
Officers
Treasurer and Other Pri
NAME OF TREASURER
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Committee Information
NAME OF COMMITTEE
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AREA CODE/PHONE
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ZIP CODE
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STATE
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NAME OF ASSISTANT TREASURER,
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AREA CODE/PHONE
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ZIP CODE
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STATE
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CITY
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MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
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AREA CODE/PHONE
ZIP CODE
STATE
CITY
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NAME OF PRINCIPAL OFFICER(S)
OP+O~A~ F~ 6~ A~D&~ ""1 """
P ~ u l \(.l.otr'c ,,If'" R. @ (i..VY\ A , L I C(!) ""'"
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
_' THAN COUNTY OF DOMICILE
s,.~ tJT'1\ Cl~Y?-"," C,OU,.."
STREET ADDRESS (NO P.O. BOX)
AREA CODE/PHONE
ZIP CODE
STATE
CITY
Attach additional information on appropriately labeled continuation sheets.
certify under penalty of
my knowledge the information contained herein is true and complete.
Verification
I have used all reasonable diligence in preparing this statement and to the best of
perjury under the laws ~f the State of California that the foregoing is true and COil
o
By
By
o
Executed on
Executed on
3.
OR STATE MEASURE PROPONENT
Executed on
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (April/2011
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772
By
DATE
Executed on