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410 Taken CC W3 (03-18-19)_R
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Statement of Organization <br />Recipient Committee <br />INSTRUCTIONS ON REVERSE <br />COMMITTEE NAME <br />P�IIP --CaKef Vesac rtP. 014-y (.(S/Lac(,om,(oPrr g clot <br />• All committees must list the financial institution where the campaign bank account is located. <br />NAME OF FINANCIAL INSTITUTION <br />cbV1ea{- gaak <br />ADDRESS <br />AREA CODE/PHONE <br />4 Type of Committee Complete the applicable sections." <br />Controlled Committee »` <br />CITY <br />t�Ne,(sl 6(h <br />BANK ACCOUNT NUMBER <br />STATE <br />ZIP CODE <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 />CHECK ONE <br />Nonparns n Partisan (list political party below) <br />Cf -e ‘ii Q--- i .pri <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 APPLICABLE) <br />CHECK ONE <br />OPPOSE <br />SUPPORT <br />SUPPORT <br />OPPOSE <br />FPPC Form 410 (August/2018) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />ci)ovr 1 lliVra 2e1.gl.rC <br />A? <br />Nonpartisan <br />Partisan <br />(list political party below) <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 APPLICABLE) <br />CHECK ONE <br />OPPOSE <br />SUPPORT <br />SUPPORT <br />OPPOSE <br />FPPC Form 410 (August/2018) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />
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