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Statement of Organization <br />Recipient Committee <br />INSTRUCTIONS ON REVERSE <br />COMMITTEE MAME <br />:11. :•. . V. Il •: :11 1 11 O. I <br />tt3. <br />o! Purpc;c Co.r., t, <br />IANUMAEA <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 <br />PROVIDE BMW mum on OF ACTIVITY <br />Sporcurrri <br />Ust additional sponsors on an attachment. <br />NAME OF SPONSOR <br />INDUSTRY GROUP OR AFRUATION OFSFONSOA <br />STREET AO RW <br />NO. AND EMIT <br />uYr <br />STME <br />IS CODE <br />AMA COM/NONE <br />.Small Cor.:ribu:or Cornmh:�•o <br />DAf• p4RRM <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 />• This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; <br />• This committee has no surplus funds; and <br />• 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 Govemment <br />Code Section 89519. <br />— Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Govemment Code Sections 89511- 89518, and are <br />subject to Elections Code Section 18680 and FPPC Regulation 18521.5. <br />FPPC Form 410 (August/2018) <br />FPPC Advice: advIce®fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />