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Statement of Organization <br />Recipient Committee <br />Statement Type Initial 0 Amendment 0 Termination — See Part 5 <br />Not yet qualified <br />or <br />0 Date qualified as committee / / / / <br />Date qualified as committee Date of termination <br />1. Committee Information <br />I.D. Number <br />(if applicable) <br />CALIFORNIA <br />FEB 16 2018 <br />For Official Use Only <br />2. Treasurer and Other Principal Officers <br />NAME OF COMMITTEE NAME QFIREASURER <br />.1) ,_,lc.�i�,e, -Rr i vers�cQe's G CO Vlb ECGUACt iva <br />\NOd1/4- <br />CITY <br />v1/4eyS t G� <br />MAILING ADDRESS OF DIFFERENT) <br />CITY,r--.� <br />STATE ZIP CODE AREA CODE P 0 <br />CA - <br />AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY <br />ic1'1cceic1())71CC/0Pl„er <br />STREET ADDRESS (NO P.O. BOX) <br />E -MA <br />CQITY OF DOMICILE URISDICJI9 WHERE COMMI EE IS ACTIVE <br />k�(�` tc1€ <br />Attach additional information on appropriately labeled continuation sheets. <br />. Veri ` cation <br />I have used all reasonable diligence in preparing this statemen <br />penalty of perjury under the laws of the State of Califo <br />Executed on Com' ! k —Q7.,Oj1SBy <br />t�DATE a P (1 <br />Executed on �`� �` By 1 <br />DATE SIGNATURE F c. NTROLLIN OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />ATE ZIP CODE AREA CODE/PHONE <br />NAME OF PRINCIPAL OFFICER(S) <br />STREET ADDRESS (NO P.O. BOX) <br />CITY <br />STATE <br />ZIP CODE <br />AREA CODE/PHONE <br />n contained herein is true and complete. I certify under <br />Executed on By <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />DATE <br />Executnc( on By <br />DATE <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />FPPC Form 410 (October/2017) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />