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Statement of Organization <br />Recipient Committee <br />INSTRUCTIONS ON REVERSE <br />COM EE NAME <br />CL <br />1 \ <br />Q L \ <br />• All committees must list the financial institution where the campaign bank account is located. <br />CALIFORNIA w 1 0 <br />FORM �+ <br />Page 2 <br />-G- NUMBER <br />NAME OF RINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER <br />l S <br />ADDRESS <br />CAL\ QS. Ca <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 i5 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 commitee. <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 DNB <br />--R;) <br />2A -t--.._ (a_k\\CA VIE 1 <br />SUPPORT <br />Nonrl <br />partisan <br />Partisan <br />(list political party below) <br />'C'1.\7--gt. <br />C.... <br />Nonpartisan <br />Partisan <br />(list political party below) <br />SUPPORT <br />OP"OSF <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(5) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION <br />{INCLUDE DISTRICT NO„ CITY OR COUNTY, AS APPLICABLE} <br />CHECK ONE <br />FPPC Form 410 (August/2018} <br />FPPC Advice: advice@fppc.ca.gov (855/275-3772) <br />www.fppc.ca.gov <br />SUPPORT <br />OPPOSE <br />SUPPORT <br />OP"OSF <br />1 <br />FPPC Form 410 (August/2018} <br />FPPC Advice: advice@fppc.ca.gov (855/275-3772) <br />www.fppc.ca.gov <br />