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HomeMy WebLinkAboutForm 410s Statement of Organization STMEMENT OF ORGANIZATION Recipient Committee Type or print in ink Dale Stamp t a StalementType initial Amendment ❑ I>] Termindll00 —See Part s ForOffklal use Only Not yet qualified ❑ or List I.D. number List I,D, number, . 5 ti 1 l 3 C 0 Date qualified es committee Dale qualified as committee Date of Termination o_ or ax✓Kaue) N N 1. Committee Information 2. Treasurerand Other Principal Officers NAME OF COMMITTEE NAME OF TREASURER o COMMITTEE TO ELECT JEFF STONE JOSEPH J. KUEBLER N 51 PEET ADDRESS 43500 RIDGE PARK DRIVE, STE. 104 Q STP.EEI ADDRESS INC PO DO %I CITY STATE ZIPCODE AREA CODEIPHONE 40335 ODESSA DRIVE TEMECUL CA 92590 (909)6 -3013 CTY 5TATE ZIP CODE AREA CODE PHDNE NAME OF ASSISTANT T REASVRER. IF ANY TEM ECULA C A 92591 ( -171 7 MAILING ADDA ESS (I F DIFFERENT) STREET ADDRESS m 435CO RIDGE PARK DRIVE, SUITE 104, TEMECULA CA 92590 Cm STATE ZIP CODE AREA COOEIPHONE O7 OPTIONAL: FAX I E-MAIL ADDRESS n O O NAME AND POSITION OF OTHER PRINCIPAL OFFICER (51,1. = APPLICABLE COVNIy OF CONICILE THAN COU COUNTY OF DOMICILE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE IAAILINO ADDRESS RIVERSIDE CITY STATE ZIPCODE AREA CODEIPHONE A ffach additional Information on appropdafefjfabeled continuation sheets. 3. Verification I have used all reasonable diligence in preparing this statementand to the best of my knowledge the info Tationconlalnedherein is elandoomplete. I Certify under penalty of perjury under the laws of the State of California thallhe foregoing is true and correct ) o Executed on �/� Z % D 61 - 714,1 SIGNATURE OF TRFASURER S5 uREA a Execuled Gn El DATE a 51 URE CF W TROUIr1G C FICEHOLDE CAN OR STATE NE /SURE PRC EKT w Executed on oAM By C3 SIGNFVRE OF CCNtPQLIAG CFFIGEHOIOEq. , CA SINE NEASUgE RiOI'ONEM C3 W Executed on D/ � DATE s I I a Y T m FPPC Form 410 (Jan/D3) FPPC Tn11.Frwt HAIn 11".: R6R /ASK -FPPC C m y m Statement of Organization SMEMENT OF ORGANIZATION N Recipient Committee TYPe °rprrntm ink _. Cate camp a , 1 a Statement Type Dlnitlal Amendment © Terminatio n –See Part 5 FwolnraluraoNly NDl yet quabW [] or List I.D. number: List I.D. number # it 1237045 f __!_J _05 31 04 Date qualified as commelee Date Qualified as committee Date of Termination O_ 111 ap{icada) N N 1. Committee Information 2. Treasurer and Other Principal Officers NAME OF COIA ITTEE NAME OF TREASURER ° COMMITTEE TO ELECT JEFF STONE JOSEPH J. KUESLER N STREET ADDRESS CI 43500 RIDGE PARK DRIVE, STE. 104 Q STRE_1 ADDRESS (NO FND BCX) --ITV STATE ZIPCODE AREA CODEPHONE 40335 ODESSA DRIVE T EMECULA C 9 2 5 90 ( 909)6 76 -3013 - _fly STATE ZIP CODE AREA ODDEIPHOrNE NAME OF ASSISTANT!RE.ASURER, IF ANY TEMECULA CA 92591 (909)693 -1719 m VAILING ADDRESS !IF DIFFERENT) STREET ADDRESS 43500 RIDGE PARK DRIVE, SUITE 104, T CA 9 2 5 90 CITY STATE Z+PCODE AREA CCO&PHONE OPTIONAL; FAX: E- AWL ADDRESS CO pI NALIE AND POSC:ON OF OTHER PRI NC:FAL OF FI CER(S), IF APPLICABLE O 01 CCJNTY Cr DCIfICILE COUNTY WHERE CLIMITTEE IS ACTI ` i °_I- DIFFERENT TI-AN CC4'VA' CF 0IN AE VAILIPJ3 ADDRESS RiVERS CITY STATE 21PCODE AREA CODEIPHONE Attach additional information on appropriately labeled con(urua (ion sheets. 3. Verification I ha ve.Ased a l l rea so nabl e d i l iga nce in prepari n g this statement and to th a best of my knowled ge the into a ti on oon tainad herein is tr and complete. I certify under penalty of perjury under the laws of the Slate of California that the foregoing is true and correct. 0 D Y Executed on al Q / 0A!�— SIGNAA.RE OF TREASURE SSI A *T LRER Executed on 6 ` ' ��_ EV °- DA 51 - A UaE OF OCNTROLUNG OFHCEHOLC . CANCI OR S•:ATE MEASURE PROPCAI'eNi LU Executed on A_E Ey D m SICNAURE [T" OCf nkOl NG CFFICEHOLIEA, Ao , OR Slam MEASURE FRCA:NEHT LU Y Executed on fay N Iv JA a o] FPPC Form 410 (Janl03) - FPPC To1LFree Heloline! 866!ASKFPPC m Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee CALIFOR D_ INS ON REVERSE Pape f COVMITTEE NAVE I.D.NUNBER COMMITTEE TO ELECT JEFF STONE 1237045 4. Type of Committee Complete theapplicablesections. a N N • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also lis tthe elective office soughtoT held, and o district number, ff any. and the year of the election. N • Listthe political party with which each officeholder or candidate is affiliated or check "non- partisan.'• T a If this committee acts jointly with another controlled committee. list the name and identification number of the other controlled committee. ELECTIVE OFFICE S060HT CR HELC NAME OF •= ANDIDKEEOFFICEHCLC•EWSTATE 61EASJRE PROPONENT ;:NCUJDE DISTRICTNUMBER IFAPPLICAEL_y YEAR OF ELECTION PARTY [X] Non.Pattissn JEFF STONE COUNCIL MEMBER CITY OFTEMECULA 2001 m _ Non - Partisan n m rn • Ustthe financial institution where the campaign bank account is located(cunholled' candidate election' committees only) 0 m NAIaE OF FINANCALINSTITJTIOr,' AREA C•aMPHONE 6AM ACCOUNT NUTA8ER MI ON O NA BANK (909j - 01 502970 ADDRESS CI STATE ZIPCODE 41530 ENTERPRISE CIRCLE S., STE. 100 TEMECULA CA 92590 Primarily formed to support or oppose specific candidates or measures in a single election. Lisl below: = CANDIOA'. E(SI \e,IAE OR h1EASUREi Sj FULL 'RLE iIMCL JDE 6ALLOT IIO a. LETTER;. (:A NDI DAT =(S) OFFICE SOUGHT CR HELO OR MEASURE(S) J URI SOICTI ON � (INCLUDE DISTRICT NO. CITY OR COUNTY,ASAPPLICAel E) CaECKCNE Sa PPORi aPPeaE o_ w suPPaar ovPOSE J m W Y a _ FPPC Form 410 (Janl03) 00 FPPC Toll -Free Helpline: 8861ASK -FPPC Y C, d N r Statement of Organization ///� STATEMENTOFOHGANILAIION Recipient Committee ��� TyP °or print In ink Date stamp 1 / R 41 1 FJLitl(n�l FEf uFi11 D�t� C>:�i __ • - statement Type Initial IN Amendment ❑ Termination — See Part 5 O; I;E Or •`..ECdE Fororlda u :eony Not yet qualified ❑ or LIsILD.number: List I.D. number. _ 4 # NOT YET RECEIVED # 01 BUG 24 raft 10 I . OCI IwtVED Os 16 01 �;i�t jONES OCT 10 20 1 —� —� —� —� —� -1 r - Date qualified as committee Date qualified as committee Date of Torminalion CA u�.C :LTI0 C ' CT4Tt CITY CLERKS DF-DTr (11 eppAraEle) ' I 1. Committee Information 2. Treasurer and Other Principal Officers NAME OF COMMITTEE NAME OF TREASURER JOSEPH J. KUEBLER COMMITTEE TO ELECT JEFF STONE STREET ADDRESS 4 35 0 0 R I D GE PA RK DRIV 111 STREET ADDRESS (NO P.O. BOX) - CITY STATE ZIP CODE AREA CODUPHONE 40335 ODESSA DRIVE TEMECULA CA 92590 (909)676 -3013 CITY STATE ZIP CODE - AREA CODEIPHONE NAME OF ASSISTANT TREASURER, IF ANY TEMECULA, CA 92590 (909)693 -171 STREET ADDRESS MAILING ADDRESS (IF DIFFERENT) SAME CITY STATE ZIPCODE AREACODE/PHONE OPTIONAL: FAX E -MAIL ADDRESS NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S). IF APPLICABLE COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT RIVERSIDE THAN COUNTY OF DOMICILE MAILING ADDRESS CITY STATE ZIP CODE AREACODFJPHONE Attach additional information on appropriately labeled continuation sheers. 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is rue and co e. I certify under penalty of perjury under the laws of the Slate of California that the foregoing is true and correct. Executed on 8/17/01 By DATE' GNgTURE OF TREASURER O ASS TANTTREASURER Executed on 8/17/01 By r PATE I URE NTROLUNGOFFICEHOLDCR CmDI E. OR STATE MEASURE PROPONENT Executedon By JEFFREY E. STONE DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, DID TE. OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OP CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 IJan101) FPPC Toll -Froo Helpllne: 866/ASK-FPPC Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee, ' INSTRUCTIONS ON REVERSE COMMITTEE NAME COMMITTEE TO ELECT JEFF STONE 4. Type of Committee Complete the applicable sections. • 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 district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "non - partisan." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. ELECTIVE OFFICE SOUGHT OR HELD NAME OF CANDIDATEIOFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY JEFF STONE COUNCIL MEMBER CITY OF TEMECULA 2001 Non - Partisan Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER MISSION OAKS NATIONAL. BANK (909)719 -1209 01502970 ADDRESS CITY STATE ZIP CODE 41530 ENTERPRISE CIRCLE S., STE. 100, TEMECULA, CA 92590 Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO.. CITY OR COUNTY. AS APPLICABLE) CHECK ONE SUPPORT OPPOSE SUPPORT OPPOSE FPPC Forth 410 (Jan /01) FPPC Toll -Free Helpline: 866 /ASH -FPPC Statement of Organization STATEMENT OF OHUANILAI ION Type or print In Ink Dale Stamp Recipient Committee !7 Statement Type [3 Initial ( Amendment ❑ Termination — See Part 5 RECEIVED Far Not yet qualified❑ or List I.D. number: Ustt.D. number: ' # NOT YET RECEIVED If AUG 2 2 2001 08 / 16 r 01 - _�_ J CITY CLERKS DEPT. Date qualified as committee Date qualified as committee Dateol Torminalion (1R .ppllrada) 1. Committee Information 2. Treasurer and Other Principal Officers NAMEOFCOMMITTEE NAME OF TREASURER JOSEPH J. KUEBLER COMMITTEE TO ELECT JEFF STONE STREET ADDRESS 43500 RIDGE PARK DRIVE, 11104 STREET ADDRESS (NO P.O. BOX) - CITY STATE ZIP CODE AREA CODEIPHONE 40335 ODESSA DRIVE TEMECULA CA 92590 (909)676 -3013 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY TEMECULA CA 92590 (909)693 -171 STREET ADDRESS MAILING ADDRESS (IF DIFFERENT) SAME CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX E -MAIL ADDRESS NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT RIVERSIDE THAN COUNTY OF DOMICILE MAILING ADDRESS CITY STATE' ZIP CODE AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets.. 3. Verification I have used all reasonable diligence In preparing this statement and to the best of my knowledge the information contained herein is rue and cc e. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 8/17/01 BY DATE GNATURE OF TREASURERO TANT TREASURER Execuledon 8/17/01 By DATE t TURE 9E.QONTROLLING OFFICEHOLDER DI E. OR STATE MEASURE PROPONENT Executed on CAN JEFFREY E. STONE DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, DID TE. OR STATE MEASURE PROPONENT ExecTtled on BY DATE SIGNAT URE OF CONTROLLING OF FICEHOLDERL CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410(Jan /01) FPPC Toll -Free Helpllne: e661ASH -FPPC Statement of Organization STATEMENT OFORGANQATION Recipient Committee. CALIFORNIA FORM INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER COMMITTEE TO ELECT JEFF STONE 4. Type of Committee Complete the applicable sections. • 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 district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "non - partisan." • If this committee acts Jointly with another controlled committee, list the name and identification number of the other controlled committee. ELECTIVE OFFICE SOUGHT OR HELD NAME OF CANDIDATE/ OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION - PARTY JEFF STONE COUNCIL MEMBER CITY OF TEMECULA 2001 Non- Panisan 0 Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION ARFACODFJPHONE BANK ACCOUNT NUMBER MISSION OAKS NATIONAL.BANK (9 - 1209 01502970 ADDRESS CITY STATE ZIP CODE 41530 ENTERPRISE CIRCLE S., STE. 100, TEMECULA, CA 92590 Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE SUPPORT OPPOSE SUPPORT OPPOSE FPPC Form 410 (Jan/01) FPPC Toll -Froo Helpllno: 866/ASK-FPPC Statement of Organization STATEMENT OF ORGANIZATION Date Stamp Recipient Committee Type or print In Ink 0 . 1 RECEIVED III Statement Type ® Initial ❑ Amendment ❑ Termination - See Part 5 I C- 1 Fwolrldal Use only Not yet qualified p< or List I.D. number. List I.D. number: AUG - 6 200 # # CITY CLERKS DEPT. Dale qualified as committee Date qualified as committee Date of Termination (11appllrabb) 1. Committee Information 2. Treasurer and Other Principal Officers NAME OF COMMITTEE NAME OF TREASURER JOSEPH J. KUEBLER Committee to Elect Jeff Stone STREET ADDRESS 43 RIDGE PARK DRIVE, #104 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIPCODE AREACODE/PHONE 40335 Odessa Drive Temecula CA 92590 (909) 676 -3 013 CITY STATE ZIP CODE AREACODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Temecula CA 92591 (909) 693 -1719 STREET ADDRESS MAILING ADDRESS (IF DIFFERENT) Same CITY STATE ZIPCODE AREACODEIPHONE OPTIONAL: FAX /E-MAIL ADDRESS NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT Riverside THAN COUNTY OF DOMICILE MAILING ADDRESS CITY STATE ZIPCODE AREACODE/PHONE Attach additional information on appropriately labeled continuation sheets. 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge a informs' contained herein is true and complete. I certify under penally of perjury under the laws of the State of California that the foregoing is true and correct. Executed on a'" - U / By DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER Executed on �- ` -O� By DATE SIGN E OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE. OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (Jan /01) FPPC Toll -Free Helnllnn- RRR /ASK -FPPC Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee CALIFORNIA FORM 410 INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER COMMITTEE TO ELECT JEFF STONE 4. Type of Committee Complete the applicable sections. • 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 district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "non - partisan." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. ELECTIVE OFFICE SOUGHT OR HELD NAME OF CANDIDATE /OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Non - Partisan I E] Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER MISSION OAKS NATIONAL BANK (909)719 - 1209 01502970 ADDRESS CITY STATE ZIP CODE 41530 ENTERPRISE CIRCLE S., STE. 100, TEMECULA, CA 92590 Primarily formed to support or oppose specific candidates or measures in a single election. List below. CANDIDATE(S) NAME OR MEASURES) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE SUPPORT OPPOSE SUPPORT OPPOSE FPPC Form 410 (Jan /01) FPPC Toll -Free Helpllne; 8001ASK -FPPC 922785 S 'I'AIT-MENI' OI' ORGANIZAI10Iv Statement of Organization Type or Print In ink. Amendment Dale Slamp CALIF , I Recipient Committee I-1 Chcck Ix,A it an Amendment „ . (Govermnent 0xie Section, 84101 - 84107) and enter I.D. nun,bee BE FILED A For Official Use Only SEE INSTRUCTIONSONREVERSE 3005111, r N14D Dt Flle orl hud and oue co of this form with: Aud If a Ilcable, file one co of 9 i the OW 0 {tt1B °rata g Py , PP PY Dale q ualifie d a s n 0 Secretary of Slate this form with: Committee:(M.x,o,,Day,Yem Slat ) of the , Political Reform Division 11c city or county officer, if arty, who S�P 2 $ of tote P.O. non 1467 receives the coulminee's original EU gauetarY_ Sacramento, CA 95812 -1467 campaign disclosure statements. Check 1wa if not yet q,Llifiul MAROHF 1 Committee Informati 11 Treasurer and Other Principal officers NAME (N COMM I I i F F �'/�G / ��OI ,1t�1r NAME OF FTIEASU1LA \ (IUP.INI 1T�� 1(i �l.�C )Ef E`I L2 — ro l RES (IFDIFFEAFN1�ANC0MITIFES) AL0Rf SSOFCOMMRTEE(FO1P . BOX)NO. ANDSIREET COUNTY: ,1 CITY J STATE ZIPCODE AREA CODFJDAYI IME M IONS � 31 % - . } C` 1r \ V�LL'r 11E i t�iL� iye�r5,ide CITY I SIAIE ZPCODE NAME AND POSIT ION OF ORIER PRINCIPAL OFFXIETI(S) Ser_IEU Lu gz�qz L(xuvco Lhl,vi MAIIINGADDRLSS ilFOIIIERENI )NO ANDSIRELIORPO. BOX MAILING ADDRESS: (P DIFFERENT T IIAN COMMIT FEE S) CITY STATE ZIP CODE ^ ^� CODE /N ZONE NUMBER CITY STATE ZIPCODE AREA COODDAYT IME M KKIE 111.9 (A -''1133 - feff1eca CGS 0)-T 1U Attach additional information on appropriately labeled continuation sheets. 111 Controlled Committee Is this committee controlled by an officeholder, candidate, or state measure proponent? (See definition and important information on reverse.) i� Yes (Complete the following) ❑ No • If this committee is controlled by an officeholder or a canFlidate, list the name of the controlling officeholder or candidate, the elective office sought or held, and district number, if any. If this committee is controlled by more than one candidate, list the name of each controlling candidate. • If this committee is controlled) by a slate measure pmponent, list the name of the slate measure proponent. If (his committee is Controlled by more than one state measure . proponent, list the name of each state measure proponent. • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. Attach additional information on appropriately labeled continuation sheers. You roust conifflele the Verification on Page 2. FOR INFORMAIIOIt RECOILED TO BE PnOVIOED to YOU PURSUANT TO THE INFORMATION PIIAC (ICES ACT OF 1971, SEE INFORMA ILQN.MMIUALQN CAb1PAIGN MC LOSUnEPRQVISI DNS DF b lEffiLIIIGALnELORRAC1 Stale of California Fair Political Practices Commission S'1'A'1'EMl_'Mf OF ORGANIZATION Statement of Organization Type or Print In ink. I Recipient Committee • S INSIRUCTIONSON REVERSE Attach additional infornuNion on appropriately labeled continuation sheets. Page 2 NAME OF COMMITTEE: IV Broad Based Committee (See definition and important infornmlion on reverse) If this is abroad based connnittee and wishes to slake contributions to candidates in excess of die $2,%) contribulion limit in connection with a spu:ial election, check the bus Wow and enter the date on or before which the conhmiuee qualified as a broad based committee. (If the conurdttee is not a broad based eouuninee, or does not wish to made contributions in excess of the $2,500 limit, do not complete this section.) ❑ Check box if this is a broad based committee. Enter [lie dale on or before which the committee qualified as a broad based conunillee: (Month. Da year) V Sponsored Committee Is this a sponsored committee? ❑ Yes 0 No (See instructions on reverse for definitions and rules regarding a sponsored conuninee's nom=.) • If yes, provide name and address of sponsor. If the commiu has more than one sponsor, provide names and addresses on appropriately labeled attachment. NAME OF SPONSOR ADDRESS OF SPONSOR NO AND STREET CITY SIAIE 21PCOOE VI Primarily Formed Committee If primarily formed to support or oppose specific candidates or measures. list specific candidates or measures below: CANDIDATE'S OFFICE SOUGHT OR HEI D OR MEASURE'S JURISDICTIOIJ CI IECK OrIE CANDIDATE'S t1AME OR MEASURE'S FULL TITLE (INCLUDE BALLOT NO, OR LETTER) (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABt E) uw'o avro.• ' Vg Committee's Primary Activity it Not Primarily Formed If not supporting or opposing specific candidates or measures, see instructions (in reverse and check ONE box to indicate if this is a: ❑ CI Committee or ❑ COUNTY Committee or ❑ STATE Committee PnOV1DE BRIEF OESCRIPI ION OF AC IFVITY -- 40 VIII Disposition of Surplus Funds You must specify what disposition will be made of surplus funds in the event of termination. Ui�C�t' fC% C hCi (l filth LC, W4(-y1 tat 10 ��►� - - - -- III Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge t Pe information contain d herein is true and complete. I certify under penalty Of perjury under the Ira //s��o the State of California . dial the foregoing is we and correct. I A I) p Executed on C I "I `JY AI la y, I Cfl_�.�1 "� By ; l% L �' "� .` _�" �`(.. : ") MI l- CITY AA 1 NDSTAI ,i /\�i�r" G E EASURFR OF m Executed on C �l��� At �Lrl���p alb )� -LL�. By iL �J DAIS CITYANDSIAIE EEC/ ss IGNAIUI OF CONnOLLING OFFICE1101 R1!II, CAIIUINAIL. IXi SIAIE M[ASURFI'ROPONENI Executed on At By _ DATE CIfYANO SIAIE SIGNAIUIIE OF CONn01.I ING OITICE1101 DIIB. CANUIUAIE IXT SIAIE MEASIIllr r101UN1 NI I Executed on At M By IE CI I Y ANU SIAIE SIGNAIIIIIE OF CONIItIX I ING OI IM:TI IIX 01111. CAIIUII )A l l'. IXI eIAII`. MEASIIIIE 1'ROfUNENI