HomeMy WebLinkAboutPerry Woodward - Form 410 - 2017 Termination (Mayor)Statement of Organization L)ateStamp
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Recipient Committee IECEIVED AND FiL El Statement Type i the office of the Secretary of S For fficial Use Only
List 0!Initial �, Amendment Termination -See Part 5 � � State of California
hotyet qualfied ❑ or I.D. number. Lis[ I.D. number:
# /375/72- MAR 27 2017.
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Date qualified as committee Date qualified as committee Date of Termination
(If applicable)
NAME OF COMMITTEE
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STREET ADDRESS (NO P.O. BOX)
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CITY STATE ZIPCODE AREACODE/PHONE
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MAILING ADDRESS (IF DIFFERENT)
.FAX /E -MAIL ADDRESS /
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COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
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Attach additional information on appropriately, labeled continuation sheets.
NAME OF TREASURER
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STREETADDRESS (NO P.O. BOX)
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CITY STATE ZIPCODE AREACODE/PHONE
.NAME OFASSISTAN7 TR URER, IF ANY
STREET ADDRESS 140 P.O. BOX) .,�
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CDT STATE ZIPCODE AREA CODE/PHONE
CA -FJ-v Z-0 (foe -ST( - F20 IV
NAME OF PRINCIPAL OFFICERS) '
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZPI CODE AREA CODE /PHONE
I have used all reasonable diligence in preparing thi Omen d'tot est f my knowteslge the information contained herein is true and cam
penalty of perjury under the laws of the State liforni at the oin u 'an rest.
:;Executed on 3/2;//7 By -
DATE GNATURE OF TREASU SSISTANT TREASURER
Z- Ely
on
DATE NATURE OF CONTROLLING OFFICEHOLDER, 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
FIRM Advice: advia
FPPC Form 410 Van/2016)
)pc.ca;gov (866/275 -3772)
www- fppc.la.gov
Statement of Orcianization
Recipient Committee
Statement Type p Initial ❑ Amendment
Not yet qualified ❑ or List I.D. number:
If
Date qualified as committee Date qualified as committee
(If applicable)
1 Committee Information
NAME OF COMMITTEE
a
Termination — See Part 5
List I.D. number:
#
/37,5/72-
3�?� t 'r
Date of Termination
-./, Z-/ c4 klo awa w ?Cl C
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIPCODE AREACODEIPHONE
7' yroLa X08 -89 Za
MAILING ADDRESS (IF DIFFERENT)
FAX/ E -MAIL ADDRESS /- O.
C'rlyG/ .VOo1W4 /C( b O G Ma �. C
COUNTY OF DOMICILE IURISDICI ION WHIRL COMMITTEE 15 ALIIVE
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Attach additional information on appropriately labeled continuation sheets.
P Date Stamp - - -) A .
i
MAR 2 4 2017 For Official Use Only
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2. Treasurer and Other Principal Officers
NAME OF TREASURER
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STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIPCODE AREACODE /PHONE
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NAME OF ASSISTANT TR ASURER, IF ANY
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STREET ADDRESS (100 P.O. BOX)
CITY r STATE ZIP CODE AREACODE /PHONE
CA qjb zo ScaB -S*9/ - 3?.?o IV
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITE
STATE Z111 CODE AREA CODE /PHONE
3. Verification ..---�
I have used all reasonable diligence in preparing thi ement,a -id to t rin est pf my knowledge the information contained herein is true an(,,' complete. I certify under
penalty of perjury under the laws of the State aliforni at the f s u an rrect.
Executed on 312- 7 �� 7 By =
DATE .-SIGNATURE OF TREASU AA551STANT TREASURER
Executed on 3/Z3/� Z— By _
DATE GNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT -
Executed on By
DATE
OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
.Executed on By
DATE SIGNATU ?.E OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov