Laserfiche WebLink
Statement of Organization <br />Recipient Committee <br />INSTRUCTIONS ON REVERSE <br />COMMITTEE NAME <br />ti <br />:4 lcy6 t t(U si _ C� �F _ UvoAcA cora D1019 <br />• All committees must list the financial institution where the campaign bank account is located. <br />CALIFORNIA41 0 <br />FORMr....., <br />Page 2 <br />I.D. NUMBER <br />NAME OF FINANCIAL INSTITUTION <br />AREA CODE/PHONE <br />BANK ACCOUNT NUMBER <br />ADDRESS <br />CITY <br />STATE <br />ZIP CODE <br />4. Type of Committee Complete the applicable sections. <br />Controlled Committee <br />® List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and <br />district number, if any, and the year of the election. <br />4 List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." Stating "No party preference" is acceptable. <br />® If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. <br />NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT <br />ELECTIVE OFFICE SOUGHT OR HELD <br />(INCLUDE DISTRICT NUMBER IF APPLICABLE) <br />YEAR OF <br />ELECTION <br />CHECK ONE <br />PARTY <br />T-1,, 1,i <br />�`- <br />. l e,c t,1.,C� , <br />tVei ;�4Ck Crh/ <br />Cath Cr 1 \tVCI cL 1 <br />Z2-�'� l <br />Nonpartisan <br />Partisan (list political party below) <br />Nonpartisan <br />Partisan (list political party below) <br />i 6 1 T IOb i t a � <br />rrroarjl+y Pol}ned Committee <br />Primarily formed to support or oppose specific candidates or measures in a single election. List below: <br />CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) <br />IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. <br />Clear Page <br />CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION <br />(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) <br />t Wct <br />€�.t ��c�-sc�c�.,�.. �ir�-�c, � u.i�c� c` <br />CHECK ONE <br />OPPOSE <br />/SUPPORT <br />OPPOSE <br />FPPC Form 410 (October/2017) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />