HomeMy WebLinkAboutBob Dillon - Form 410 - TerminationStatement 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:
Date qualified as committee
(If applicable)
1. Committee Information
NAME OF COMMITTEE
63 [� �j� l � GT'/ Cdc1911L
Date Stamp
Termination — See Part 5 F,!..I' VA
List I.D. number: nl �Ryo :! C
# d�
Date of Termination
2. Treasurer and Other Principal Officers
NAME OF TREASURER
STATEMENT OF ORGANIZATION
Use Only
J 1 Mr= 1 HUURCJJ tIVU r.U. 6UA) CITY STATE ZIP CODE AREA CODE /PHONE
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CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY
4�_/ L " --
�Q� Irl <f't � o STREET ADDRESS
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX/ E -MAIL ADDRESS
COUNTY OF DOMICILE I COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
SkNTi� r-"&
Attach additional information on appropriately labeled continuation sheets.
CITY STATE ZIP CODE AREA CODE /PHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS
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 lags /oft l State of California that the foregoing is true
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 (January/05)
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