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Statement of Organization CALIFORNIA ^��M <br />���� e�� N0J <br />Recipient Committee�� �K�___ - �`� <br />' <br />INSTRUCTIONS ON REVERSE <br />Page 2 <br />COMMITTEE NAME , LID. NUMBER <br />^ All committees must list the financial institution where the campaign bank account is located. <br />NAME orFINANCIAL /mSTIrmmw <br />ARmmopPHowc <br />BANK ACCOUNT NUMBER <br />ADDRESS on rmr E ZIP CODE <br />� <br />4� CA <br />° <br />List the name ofeach controlling officeholder, candidate, orstate measure proponent. |fcandidate orofficeholder controlled, also list the elective office sought o/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 />a |fthis committee acts jointly with another controlled committee, list the name and identification number ofthe other controlled committee. <br />ELECTIVE OFFICE SOUGHT nnHELD YEAR OF PARTY <br />NAME OF CAN DI DATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE <br />Primarily formed to support or oppose specific candidates or measures in a single election. List below: <br />CAmo/omE(sNAME oxmcmmx$sFULL TITLE (INCLUDE BALLOT NO. onLETTER) <br />IF A RECALL, STATE "RECALU IN FRONT OFTHE OFFICEHOLDER'S NAME. <br />memmTE($opnCE SOUGHT oxHELD oxmEAmm(S) JURISDICTION <br />(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) <br />CHECK ONE <br />OPPOSE <br />FPpCForm 41VKugust/2o10 <br />pPpCAdvice: advice@fppc.ca.gov(866/z75-3772) <br />Nonpartisan <br />Partisan <br />(list political party below) <br />Nonpartisan <br />Partisan <br />(list political party below) <br />Primarily formed to support or oppose specific candidates or measures in a single election. List below: <br />CAmo/omE(sNAME oxmcmmx$sFULL TITLE (INCLUDE BALLOT NO. onLETTER) <br />IF A RECALL, STATE "RECALU IN FRONT OFTHE OFFICEHOLDER'S NAME. <br />memmTE($opnCE SOUGHT oxHELD oxmEAmm(S) JURISDICTION <br />(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) <br />CHECK ONE <br />OPPOSE <br />FPpCForm 41VKugust/2o10 <br />pPpCAdvice: advice@fppc.ca.gov(866/z75-3772) <br />