HomeMy WebLinkAbout2011 - Form 410 Initial
Type Or print in ink
S'ta"tement of Organization
Recipient Committee
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o Termination - See Part 5
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Date of Termination
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Date qualified as committee
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Date qualified as committee
Officers
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ZIP CODE AREA CODE/PHONE
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Committee Information
NAME OF COMMITTEE
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NAME OF ASSISTANT TREASURER, ~NJ A-
AREA CODE/PHONE
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e, )UNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
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MAILING ADDRESS
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY
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AREA CODE/PHONE
ZIP CODE
STATE
Attach additional information on appropriately labeled continuation sheets.
Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge
perjllry under the laws of the State of California that the foregoing is true and correct.
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certify under penalty of
the information contained herein is true and complete.
RE OF TREASURER OR ASSISTANT TREASURER
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NG OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
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SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
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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)
DATE
on
Execllte(
STATEMENT OF ORGANIZATION
Statement of Organization
Recipient Committee
D. NUMBER
NSTRUCTIONS ON REVERSE
COMMITTEE NAME
-PAUL \:
4. Type of Comm
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ittee Complete the applicable sections.
controlled, also list the elective office sought or held, and
candidate or officeholder
If
is affiliated or check "non-partisan.
list the name and identification number
state measure proponent.
candidate
controlled committee,
List the name of each controlling officeholder, candidate, or
district number, if any, and the year of the election.
which each officeholder or
jointly with another
List the political party with
If this committee acts
.
.
of the other controlled committee.
.
PARTY
on-Partisan
o Non-Partisan
YEAR OF ELECTION
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPI..ICABLE)
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NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
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"candidate election committees only
BANK ACCOUNT NUMBER
is located (controlled
AREA CODE/PHONE
institution where the campaign bank account
NAME OF FINANCIAL INSTITUTION
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List the financia
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ZIP CODE
STATE
CITY
ADDRESS
Primarily formed to support or oppose specific candid
CANDIDATE(S) NAME OR M
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SUPPORT OPPOSE
FPPC Form 410 (Apri1/2011)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)
STATEMENT OF ORGANIZATION
Date Stamp
o Termination - See Part 5
List I.D. number:
Type or print in ink
W Amendment
Ust LD number:
#
Statement of Organization
Recipient Committee
or
D
o Initial
Not yet qualified
Statement Type
.
2011
DEe
#
1----1_
~ate of Termination
~ OI/"l.OII
Date qualified as committee
(If applicable)
Officers
2. Treasurer and Other Princlpa
NAME OF TREASURER
----1 I
Date qualified as committee
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STREET ADDRESS (NO P.O. BOX)
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ittee Information
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NAME OF COMMITTEE
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ZIP CODE
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N'A'ME OF ASSISTANT TREASURER, IF ANY
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AREA CODE/PHONE
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ZIP CODE
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STATE
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MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
AREA CODE/PHONE
ZIP CODE
STATE
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CITY
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(,.. "^ ~ \t.. " (. Cl N\
coOI-i?,y .vH~"1:: COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
OPTIONAL:
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COUNTY OF DOMICILE
E-MAIL ADDRESS
FAX
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
s~ ~\ ~ <:. \",'Q. u~
AREA CODE/PHONE
ZIP CODE
STATE
CITY
Attach addilional information on appropriately labeled continuation sheets.
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
perjury under the laws of the State of California that the foregoing is true and correct,
certify under penalty of
By
Executed on
OR STATE MEASURE PROPONENT
By
Executed on
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
By
DATE
Executed on
SIGNATURE OF CONTROLLING Oi'FICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Apri1/2011)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
By
DATE
Executed on
STATEMENT OF ORGANIZATION
Statement of Organization
Recipient Committee
D. NUMBER
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NSTRUCTIONS ON REVERSE
COMMITTEE NAME
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4. Type of Committee Complete the applicable sections,
If candidate or officeholder controlled. also list the elective office sought or held, and
is affiliated or check "non-partisan.
list the name and identification number
List the name of each controlling officeholder, candidate, or state measure proponent.
district number, if any, and the year of the election.
List the political party with which each officeholder or candidate
If this committee acts jointly with another controlled committee
.
.
.
of the other controlled committee.
PARTY
-:r-Q~L '''-1- V- \....0 ~ C. \L-\:;.~ G\\, CeUNG\.. - ~L{2.0'i Le:,\'L ~ Non-Partisan
o Non-Partisan
YEAR OF ELECTION
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
. 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
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ADDRESS CITY STATE ZIP CODE
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imarily Formed Committee 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
I I ,~~ r~"
SUPPORT OPPOSE
FPPC Form 410 (ApriI/2011)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)