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Statement of Organization <br />Recipient Committee <br />Statement Type 0 Initial <br />Q Not yet qualified <br />or <br />Q Date qualification threshold met <br />/ / <br />® Amendment <br />Date qualification threshold met <br />1 / 30 / etc <br />ommittee lniarmmatian : ; I.D. Number p ii <br />(if applicable) 0 — 3 2 <br />NAME OF COMMITTEEL V A 4 CA, es <br />{ r F r t „ -7 0 q c( <br />0 Termination — See Part <br />Date of termination <br />STREET ADDRESS (NO PO: BOE) <br />R rk. <br />CITY <br />Isun <br />For Official Use Only <br />NAME OF TREASURER <br />DNA/ i c} (e r. ' <br />pal 01 <br />CITY <br />R itte. <br />STATE <br />ZIP CODE <br />AREA CODE/PHONE <br />FULL MAILING ADORERS (IF DIFFERENT) <br />E•MAIADDRESS (REQUIRED) / FAR (OPTIONAL) <br />COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE <br />R rver7rr C* DF R.versrJed [fir <br />7 <br />Attach additional information on appropriately labeled continuation sheets. <br />3. Verification <br />I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete, 1 certify under <br />penalty of perjury under the laws of the State • • - • ...II ing is true and correct, <br />STATE <br />NAME OF ASSISTANT TREASURER, IF ANY <br />iltCCA 1 earl d <br />ZIP CODE <br />AREA CODE/PHONE <br />STREET ADDRESS NO PA, Bo) <br />NAME OFIINCIPAL OFFICER(5) <br />STREET ADDRES <br />CITY <br />.rb <br />rt <br />C vers rc <br />STAT <br />IP CODE <br />AREA CODE/PHONE <br />Executed an <br />2. -2_0- ? <br />DATE <br />Executed an r2-0 2a1 <br />DATE <br />By <br />By <br />Executed on By <br />DATE <br />Executed on By <br />DATE <br />SIGNATURE OF TREASURER OR ASSISTANT TREASURER <br />CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />FPPC Form 410 (August/2018) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />