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Statement of Organization <br />Recipient Committee <br />INSTRUCTIONS ON REVERSE <br />CALIFORNIA 410 <br />FORM <br />Page 2 <br />COMMITTEE NAME -77 <br />1A.)04/& -7- <br />A.- 4/& Slc 1 t_e73 E,C-/J)3 6: / 't S r a / e- / <br />I.D. NUMBER <br />• All committees must fist the financial institution where the campaign bank amount is located <br />NAME OF FINANCIAL INSTITUTION <br />ADDRESS <br />r1'l-6, c: j am k <br />AREA CODE/PHONE <br />CITY <br />BANK ACCOUNT NUMBER <br />5TAT E <br />CYr"- <br />Z1P_{.J]E <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 CANDIDATEJOFFICEHOLDERJSTATE MEASURE PROPONENT <br />ELECTIVE OFFICE SOUGHT OR HELD <br />;INCLUDE DISTRICT NUMBER IF APPLICABLE} <br />YEAR DF <br />ELECTION <br />PARTY <br />CHECK ONE <br />+ A ;.5.K I L G• <br />J( 4iL7 !i'. <br />( / 7—if Cc. t ,L.�:. iL 1,,...A-40 7 <br />,_;21.)9 <br />Nonpartisan <br />LJ <br />Partisan <br />(list political party below) <br />■ <br />OPPOSE <br />■ <br />Nonpartisan <br />Partisan <br />(list political party below) <br />III <br />Primarily Formed Committee <br />Primarily formed to support or oppose specific candidates or measures in a single election. List below: <br />CANDIDATE(5) NAME OR MEASURE(S) FULL TITLE )INCLUDE BALLOT NO. OR LETTER) <br />IF A RECALL, STATE 'RECALL" IN FRONT DF THE OFFICEHOLDER'S NAME. <br />CAN DIDATEIS}OFFICE SOUGHT OR HELD OR MEASURE(SI 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 (866/Z7S-3772) <br />www.fppc_ca.gov <br />SUPPORT <br />n <br />OPPOSE <br />❑ <br />SUPPORT <br />n <br />OPPOSE <br />■ <br />FPPC Form 410 {August/2018) <br />FPPC Advice: advice@fppc.ca.gov (866/Z7S-3772) <br />www.fppc_ca.gov <br />