Laserfiche WebLink
vrin <br />Statement of Organization <br />Recipient Committee <br />Statement Type, 0 initial <br />n Am <br />Termination—See Part <br />0 Not yet qualified TO <br />OF de <br />0 Date qualification threshold met Date qualification hre 1,09- Date of termination <br />i0i �t "S <br />T1-1 <br />4:5L,61--47 DA) &AI /4i <br />STATE ZIP CODE <br />CA— <br />FULL MAILING ADDRESS (IF DIFFERENT) L—M <br />E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) <br />-N I Y UF UUMILILE JURISDICTION WHERE COMMITTEE 15 ACTIVE <br />Verd e <br />- � 3,' I <br />Attach additional information on appropriately labeled continuation sheets. <br />r 't i ra <br />0 <br />Date Stamp <br />gr Official Use Only <br />RTEC IVED <br />9PUG —9 PH12:46 <br />I ''I I elan <br />NAME OF TREASURER of the State of Callfornig­ <br />bIAIL ZIPCODE AREA CODE/PHONE <br />C/1— <br />NAME OF ASSISTANT TREASURER, 11 ANY <br />/ <br />STREET ADDRESS (NO P.O. BOX) <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />NAME OF PRINCIPAL OFFICER(S) <br />5 1 KLt:1 AVE) RESS (NO P.O. BOX) <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />g — im y �- -,A <br />PeTOWN1W. , , 11 a <br />I have used all reasonable diligence ir-preparing this statement and to the be fined herein is true and complete. I certify under <br />penalty of perjury under the laws of the State of C lfo <br />Executed on 5 By <br />DATE <br />llllllllllllllllllll`REA5URER <br />Executed on <br />By <br />DATE <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />Executed on By <br />PATE, <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />Executed on <br />y <br />DATE <br />-- R <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATEMEASURE <br />FPPC Form 410 (August/2018) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />W. <br />