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Statement of Organization <br />Recipient Committee <br />INSTRUCTIONS ON REVERSE <br />CALIFORNIA <br />FORM <br />410 <br />Page 2 <br />COMMITTEE NAME <br />Dr. (A) i IE Peairce, dor Gt r <br />• All committees must list the financial institution where the campaign bank account is located. <br />NAME OF FINANCIAL INSTITUTION <br />ADDRESS <br />5ct,o0 P r5 - FCUL <br />L <br />CITY <br />BANK ACCOUNT NUMBER <br />STATE <br />C4 <br />XIP CODE <br />I.D. NUMBER <br />c'3 -y173 <br />0i <br />l <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 />• 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 />PARTY <br />(/6 .p Il 1-kret hPeck.rte_ <br />iA)xrd 7 CI -6 Cownc,.I—►h of- RISS; <br />20ll <br />Nonpartisan <br />Partisan <br />(Ilse political party below) <br />Nonpartisan <br />Partisan <br />F <br />(list political party below) <br />I <br />Primarily Formed 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 />CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION <br />(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPUCARLE) <br />CHECK ONE <br />OPPOSE - <br />SUPPORT <br />n <br />SUPPORT <br />FPPC Form 410 (August/2018) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />