Laserfiche WebLink
Statement of Organization <br />Recipient Committee <br />INSTRUCTIONS ON REVERSE <br />E <br />COMMITTNq \i 1, ( 1 WA.e-- ' K R Y e s(C..r1.e.._. &I- <br />4. Type of Committee (continued) <br />General Purpose Committee <br />Couicu( Waka 1 aci9 <br />Not formed to support or oppose specific candidates or measures in a single election. Check only one box: <br />0 CITY Committee 0 COUNTY Committee 0 STATE Committee ❑ Political Party/Central Committee <br />PROVIDE BRIEF DESCRIPTION OF ACTIVITY •--ro c* ----() <br />i s- �,� J <br />C_O,Arv\-ec ci _ C) x•��� k- '- c' a u~l�t& :?tot <br />Spansored Committee <br />List additional sponsors on an attachment. <br />CALIFORNIA' <br />FORM <br />pLur poi .- -i.t ctivi.,c <br />r verSacL... C Cii/lt"�lrC:l <br />NAME OF SPONSOR <br />INDUSTRY GROUP OR AFFILIATION OF SPONSOR <br />STREET ADDRESS <br />NO. AND STREET <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />Small Contributor Committee <br />0 / / <br />Date qualified <br />5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the fallowing conditions have been met: <br />• This committee has ceased to receive contributions and make expenditures; <br />® This committee does not anticipate receiving contributions or making expenditures in the future; <br />O This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; <br />i This committee has no surplus funds; and <br />Q This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. <br />-- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government <br />Code Section 89519. <br />-- Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511- 89518, and are <br />subject to Elections Code Section 18680 and FPPC Regulation 18521.5. <br />Clear xPage 11 <br />Print <br />FPPC Form 410 (October/2017) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />