HomeMy WebLinkAbout410s Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee TYpeorprintinink REC IVED9 RD"FILE
In the o ice of the Secretary of Stat
. -
o the State of California
Statement Type E] Initial F] Amendment Termination — See Part 5 For Orfidel Use Only
q ualified or List I.D. number: List I.D. number:
Not et
v q p JAN 2 9 2004 # # /2s 73 KEVIN HELLEY, Secretaryof Sta FYI Ef i!"ir
Date qualified as committee Date qualified as committee Date of Termination
(I. RECEIVED
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF TREASURER — L. L ir STREET ADDRESS
4-o 4- to
STREET ADORES O P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE
444 RAXro.� �'� t6A•4W X04 6pf - 868 9
CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY
[`6q £CJ (t 4 C44 t ys` f � " 644 -$ " s-,
MAIJN''G,, ADDRESS (IF DIFFERENT) STREET ADDRESS
5 CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E -MAIL ADDRESS
Col•< NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
COUNTY Ot DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
' MAILING ADDRESS
CITY STATE - ZIPCODE 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 in f ati n contained Brain is true and complete. I certify under penalty of
perjury under the laws of the State of California that the foregoing is true and re t.
Executed on _ ��A — Ely
! SI NRUR URER OR ASSISTANT TREASURER
Executed on f /Z / t, ey
DATE n' SIGNRURE OF CONTROLLING O FICEHCLDER. CANDIDAE, OR STATE MEASURE PROPONENT
Executed on DATE u
SIGN/OURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE SIGNKURE OF CONTROLLING OFFICEHOLDER. CANDIDATE, OR S TATE
FPPC Form 410 (Jan/03)
FPPC Toll -Fnea H.lolhw: RWASKFPPC
Statement of Organization ST)I EMENT OF ORGANIZATION
Recipient Committee Type or print in ink •
Date Stamp
RECEIVED
Statement Type Initial E] Amendment IrTermination — See Part 5 C ForOflldel Use Only
Not yet qualified ❑ or List I.D. number. `List q .D. number: JAN G 6 2004
# # 73 C ITY CLERICS DEPT.
— If I 1 am t4
Date qualified as Committee Date qualified as committee Date of Termination
(i1 aWi aus)
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF TREASURER
Q�3c"RT S. �(lp -rr Aga QX7 S• parr
STREEA
o F^ I ,4 -rD,) a oL
STREET ADDRES O P.C. BOX) CITY `t- Z K STATE ZIP CODE AREA CODE/PHONE
Z 6H4'&2 k4 f l cf! 1 6?( bl?
CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY
7'e! (£CJ Ito GrA Qis91 t f�9)�4k -fib
MAILING ADDRESS (IF DIFFERENT) STREET ADDRESS
5A7G(4- CITY STATE ZIP CODE AREA CODEIPHONE
OPTIONAL: FAX / E -MAIL ADDRESS �+
+e _ `,( NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
COUNTY OV DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
MAILING ADDRESS
Attach additional information on appropriately labeled continuation sheets. CITY STATE ZIP CODE AREA CODEIPHONE
3. Verification
have used all reasonable diligence in preparing this statement and to the best of my knowledge the inf mati n contained erein is true and complete. I certify under penalty of
perjury under the laws of the State of California that the foregoing is true and re t.
Executed on / (wit °i� W
/b •'- 51 NWUR EASURER OR ASSISTANT TREASURER
Executed on 1 I Z4 T g', ` .
DATE SIGNIPURE OF CONTROLLING OFFICEHOLDER, CANDIDArE, OR STATE MEASURE PROPONENT
Executed on �,
DATE SIGNiffURE OF CONTROLLING OFFICEHOLDER, CANDIDWE, OR STATE MEASURE PROPONENT
Executed on g
DATE SIGNArURE OF CONTROLLING OFFICEHOLDER, CANDID/PE, OR ATE M EASURE
FPPC Form 410 (Jan/03)
FPPC Toll Froa Helolim: SMASK.FPPC
Statement of Organization { STATEMENT OF ORGANIZATION
Type Date Stamp
Recipient Committee 3 e or rint in Ink . - 7 ravc Statement Type �nitial 0 Amendment E] Termination— SeePar Ic 15t�ate Foroflid I.D. number. List I.D. number. Not yet qualified or o the State of California
# # AUG O 7 2003 —� J � — Date qualified as Committee Date qualified as committee Date of Termination KEVIN HELLEY,Secretary ofStat (if aPPII�+Ne)
rr PT
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF TREASURER
SAk� T� X Ce>AJOe llLae\ —z 5 • `�Ra -r:
STREET ADDRESS
STREET ADDRESS (NO F.O. BOX) '' �21 E 000 (I JE
CITY STATE ZIP CODE AREA CODE/PHONE
,4o4 - ?r-> (CacCcJLA (2 4 4zSRl 9o�i -6 i86�9
CITY ,^. ll STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY
�` � (4 9z5 ( q�'644 STREET ADDRESS
MAILING ADDRESS (IF DIFFERENT)
Jkitt; . CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E -MAIL ADDRESS
AA-%L fA �O -K,BCJ . Coot NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
COUNTY OF &OMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Pt
MAILING ADDRESS
t�i;2s�9r
CITY STATE ZIPCODE AREA CODE /PHONE
Attach additional information on appmpnately labeled continuation sheets.
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the info n contained herein is true and complete. I certify under penalty of
perjury under the laws of the State of California that the foregoing Is true and correct
Executed on Jvw 3 r 1 2003 �, . DATE EV SIGN URE pF URER OR ASSISTANT TREASURER-' -
• i Executed on Jr�/�{ 3 ( 2V03
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDAE. OR STATE MEASURE PROPONENT
Executed on GATE E -
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDA E, OR STATE MEASURE PROPONENT
Executed On By
DATE SIGNA OF WNTROLUNG DER CANDIDATE OR STATE MEASURE PROPONE
FPPC Form 410 (Jan/03)
FPPC Toll•Fra i Haloline: BGSIASK -FPPC
Statement of Organization STATEMENT OF ORGANIZATION
M Type or print in ink Dale Stamp
Recipient Committee. J r \tE� ,
V NED N S,D p\V \S1 •
RM
Statement Type ❑ Initial E] Amendment Termination — See Part 5 90 1- MCPSECRERA Y CF For Official Use Only
Not yet qualified 17 or List I.D. number: List I.D. number: FF \CE OF
1235262 �VN O 5 2001
It I_1 1 1 12 1 31 / 99 �C�ES A1E
Date qualified as committee Date qualified as committee Date of Termination 6\0- RY pF SN
(It Apprranle) R A
1. Committee Information 2. Treasurer and Othe rii cipal Officers
NAME OF COMMITTEE NAME OF TREASURER
Committee to Elect Sam Pratt
STREET ADDRESS
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE
40470 Brixton Cove
CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY
Temecula CA 92591 (909) 699 -8689
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
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 y no Ed a the info atio nt Inedher6d ue and complete. I certify under penalty of
perjury under the laws of the State of California that the foregoing is true and correct
Executed on .l 11f /0 I By t
OAT A ASSISTANT TREASURER
n
Executed on ( 01 B I
DATE SIGNATUREOFC TROLLINGOFFICEHOLD DANDIDATE,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 Helpline: 8661ASK -FPPC
Staterfr rlt t9t Or ganization STATEMENT OF ORGANIZATION
Recipients Committee R • ,3 Ty pe or print in ink 123 26 C/ Date Stamp e ,
' � 1
Statement Ty Initial Amendment Termination — See Part BECE ED AND FILED
YP ® REFORM ONISION For Onolal Use Only
a List I.D. number. List I.D. number: pOIITICA CRETARY OF STATE
Not yet qualified
1235262 OFFICE OF E
# " J N292001
_lam 10 1 6 1 99 —J_ 1
Dale qualified as committee Dale quallfied as committee Date of Termination ILL JONES
(it appkal e) A
1. Committee Information 2. TreasurerVIT&W i6r Principal Officers
NAMEOFCOMMITTEE NAME OF TREASURER
Committee to Elect Sam Pratt Albert S. "Sam" Pratt
STREET ADDRESS
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE
CITY STATE 21P CODE AREA CODEIPHONE
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS
MAILING ADDRESS (IF DIFFERENT)
CITY STATE ZIPCODE AREA CODEIPHONE
OPTIONAL: FAX IE-MAIL ADDRESS
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE MAILING ADDRESS
CITY STATE ZIP CODE AREA CODEIPHONE
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 kn edg t e kinfoation tai d herein i rue and complete. I certify under penalty of
perjury under the laws of the State of California that the foregoing is true and coned.
Executed on (J - L6 A I By i AA �
PATE URE URER ANT TREASURER
Executed on Iohi 7O t By
0.47E V SMNATU RE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
Executed Or 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 -Fred NP.Inlinp- RSSIASN -FPPC
Stat0 of Organization STATEMENT OF ORGANIZATION
Recipient Committee CALIFORNIA ,
FORM
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I.D.NUMBER
Committee to Elect Sam Pratt 1235262
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 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
Albert S. "Sam" Pratt Temecula City Council 1999 ❑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
California Bank & Trust (909) 699 -6368 2270017126
ADDRESS CITY STATE ZIP CODE
30580 Rancho California Road Temecula CA 92591
primarily formed to supports 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(5) 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 (Jan101)
FPPC Toll-Free Helpline: 8661ASK -FPPC
P r1 tlY(a
.St atement of Organization T STATEMENT OF ORGANIZATION
Recipient Committee ypeor rintln COP lnk ALREDFOpm6 is
/ O t �E O ORM DMD
' CAUFORN
(Z56 o Z OF SECRET
A RY OF StA
Statement Type [� Initial ❑ Amendment ❑ Termination — See Part 5 For Official Use Only
Not yet qualified ❑ AY or List I.D. .. number: List I.D. number: 2 2 20o1
10 6 99 �� �� Cq ECRE7ARy es
Date qualified Date qualified as committee Date of Termination OF STATE
(il applicable)
1. Committee Information 2. Treasurer and Other Principal Office
NAME OF COMMITTEE NAME OF TREASURER
Albert S. "Sam" Pratt
Committee to Elect Sam Pratt STREET ADDRESS
40470 Brixton Cove
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE
40470 Brixton Cove Temecula CA 92591 (909) 699 -868
CITY STATE ZIP CODE AREACODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
Temecula CA 92591 (909) 699 -8689
STREET ADDRESS.
MAILING ADDRESS (IF DIFFERENT)
CITY STATE ZIPCODE AREA CODEIPHONE
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
THAN COUNTY OF DOMICILE MAILING ADDRESS
CITY STATE ZIPCODE AREACODE/PHONE
Attach additional information on appropriately labeled continuation sheers.
3. Verification
I have used all reasonable diligence in preparing this statement and to the best o ' y kn ledge e ' ormati n conta ed herein is true and complete. 1 certify under penalty of
perjury under the laws of the State of California that the foregoing is true and c rr ct.
Executed on S I g — � I By
DATE S N U EASURER OR ASSISTANT TREASURER
Executed on - -0 j By -
DATE SIG TUREOFCO O INGOF ICEHOLDER, 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 Helnllnrt- RRR /ASK -FPPC
May 18, 2001
Secretary of State
Political Reform Division
P.O. Box 1467
Sacramento, CA 95812 -1467
Dear Sirs:
Enclosed is a Form 410, Statement of Organization, for Albert S. "Sam" Pratt. I ran for a City
Council seat for the City of Temecula in November of 1999. Originally I did not anticipate raising or
spending more than $1,000. 1 was not aware that once I did raise $1000, 1 needed to file a Form
410. The Fair Political Practices Commission informed me that I should file the form now. Please
accept my apologies.
ease feel free to cc a e if you have any questions.
Sne
Albert S. "Sam" Pratt
40470 Brixton Cove
Temecula, CA 92591
(909) 699 -8689
Enclosure
Statement of Organizat STATEMENT OF ORGANIZATION
Type or print In Ink Date Stamp
Recipient Committee CAILIFORNIA ,
FORM Statement Type ❑ Initial ❑ Amendment ❑ Termination - See Part 5 (RECEIVED For Official Use Only
Not yet qualified ❑ or List I.D. number: List I.D. number: '
# MAY 18 2001
#
10 t 6 99 (YY CLERKS DEPT:
Date qualified as committee Date qualified as committee Date of Termination
(il applicable)
1. Committee Information 2. Treasurer and Other Principal Off icers
NAME OF COMMITTEE NAME OF TREASURER
Albert S. "Sam" Pratt
Committee to Elect Sam Pratt STREET ADDRESS
40470 Brixton Cove
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE
40470 Brixton Cove Temecula CA 92591 (909) 699 -868
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
Temecula CA 92591 (909) 699 -8689
STREET ADDRESS
MAILING ADDRESS (IF DIFFERENT)
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
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 0 y kn ledge e tin ' conta ed herein is true and complete. I certify under penalty of
perjury under the laws of the State of California that the foregoing is true and c IT ct.
Executedon S - i g - � 1 By
DATE 5 N U EASURER OR ASSISTANT TREASURER
Executed on S� L�-O i 8y '
DATE SIG TIRE OFCO O ING OF ICEHOLDER, 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 -Frew Helnlinr ReBIASR -FPPC
-33 Y�a30
Recipient Committee 1. WHERE TO FIL E : RECIPIENT RMIN
�STATF�IIF�JT OF TERMINATION
Statement of Termination File original and one copy of this form with: Det s
Secretary of State ECEIVE� lft Fi I.,e rl t
This form must be completed by recipient committees Political Reform Division I the office of the Secretary o , f ifs
that are eligible to terminate pursuant to Government P.O. Box 1467 of the State of Califorlt(� JAN For official use0 Y
Code Section 84214. Sacramento, CA 95812 -1467 8 1r1(T�
And, if applicable, file one copy of this form with: DEC 1 D 19 n f JJJ
Type or print in ink. The city or county officer, it any, who receives the
committee's campaign disclosure statements.
ILL JONES, Secretary of to
I Recipient Committee Information II Treasurer Information
NAMEOFCOMMFTTEE I.D. NUMBER NAM TREASURER
MAILING ADDRESS OFTREASURER NO, AND STREET
ADDRESS OF COMMITTEE NO. AND STREET���
//�O� CITY STATE ZIP CODE
CITY STATE ZIP CODE J `���i' r � G - "��� 5
AREA CODE/DAYTIME PHON NUMBER
AREA CODEIDAYTIME PHONE NUMBER G � 7 �/
III Effective Date of Termination
DATE FILING OBLIGATIONS WERE COMPLETED
IV Verification
A. This committee has ceased to receive contributions and make expenditures;
B. This committee does not anticipate receiving contributions or making expenditures in the future;
0 C. This committee has eliminated or declares that it has no intention or ability to discharge all debts, loans received, and other obligations;
D. This committee has no surplus funds; and
E. This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
I have used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained herein
is true and complete. I certify under penalty of perjury under the laws of the State of California th�t the foregoing rue and correct.
Executed on I I �C� At ! �,l�Lid , l�Y y� d '7 I By
D TE 'CITY AND STATE IG ATU TREASUflER
Executed on 1 Al ' f teo lW1 cif �/.ny ! By ,''
15 ATE CITY AND STATE U E OF CONTROLLIN ICEHO ER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on At By
DATE CITY AND STATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on At By
DATE CITY AND STATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FOR INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INFORMATION MANU6L MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE PO ITI A REFORM A T
Stale of California Fair Political Practices Commission
RECIPIENT COMMITTt
Recipient Committee WHERE TO FILE STATEMENT OFTERMINATION
Statement of Termination File original and one copy of this form With: DatsSlamp — I
Secretary of State TI r r :. + i
This form must be completed by recipient committees Political Reform Division
that are eligible to terminate pursuant t0 Government P.O. Box 1467 For Official Use Only
Sacramento, CA 95912 -1467 f f ' ju
Code Section 84214. .� Jyb � 1 . t, : -. i
And, H applicable, file one copy of this form with: 1
Type or print in Ink. The city or county officer, if any, who receives the T` , 07 U L_i
committee's campaign disclosure statements. --- ---------------------
- -
I Recipient Committee Information II Treasurer Information
NAME OF COMMITTEE I.D.NUMBER NAME FTREASURER
MAILINGADDRESS OF TREASURER / NO. AND
AD ESS OF COMMITTEET NO. AND STREET c/ G L���f��� S ��C
fj� J � y � CITY �] STATE ZIP CODE
/ CITY A STATE CLJ ZIPCODE -���
AREA CODEIDAYTIME PHONE NUMBER
AREA CODEIDAYTIME PHONE NUMBER ��� > `I
9o9— & III Effective Date of Termination
DATE FILING OBLIGATIONS WERE COMPLETED
IV Verification
A. This committee has Ceased to receive contributions and make expenditures;
B. This committee does not anticipate receiving contributions or making expenditures in the future;
�- C. This committee has eliminated or declares that it has no intention or ability to discharge all debts, bans received, and other obligations;
D. This committee has no surplus funds; and
E. This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
I have used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained herein
is true and complete. 1 certify under pena of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on I I t) 4 v At 1 �.f(7(/ L 1.111. _ By / .�'� `r -
D TE ' C I TY AND STATE IG ATU TREASURER
Executed on At �w� [A a �Gb'7 1 By .
ATE CITY AND STATE U EOF CONTROW ICFH ER CANDIDATE, OR STATE MEASURE PROPONENT
Executed on At B
DATE U1 I Y ANU 5 IAI h SIGNATURE OF CONTROLLING OFFICEHOLDER CANDIDATE, OR STATE MEASURE PROPONENT
Executed on At By
DATE CITY AND STATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FOR INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROYISIONS OF THE POUTICAI REFORM Ac
State of California Fair Political Practices Commission
..Woo
i OFFICEHOLDER AND CANDIDATE
Ctfficeehiolder and Candidate STATEMENT OF TERMINATION
Statement of Termination Date Stamp ---7
This form must be completed by officeholders and WHERE TO FILE: rl no=
candidatesthat are eligibleto terminate pursuant Officeholders and candidates must file For Official Use Only
to Government Code Section 84214. Form 416 with the filing officer with D t j 1996 U
I
whom they filed their original campaign I
Type or print in ink. statements (Form 470 or 490). L'L
----------------------
I Officeholder or Candidate T erm in at i on II Office Sought or Held
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE OUG OR HELD FOR WHICH YOU ARE FILING THIS STATEMENT
RFCIDE
�7v 25��✓i 1
CITY STATE ZIP CODE III Effective Date Terminati
DATE FILING OBLIGATIONS WERE COMPLETED
AREA CODEIDAYTIME HONE NUMBER
IV Verification
For the office listed in Part II of this form, I verify that:
A. I do not hold or am no Idnger a candidate for the office;
B. I have ceased to receive contributions and make expenditures;
C. I do not anticipate receiving contributions or making expenditures in the future;
D. I have eliminated or I declare that I have no intention or ability to discharge all debts, loans received, and other obligations;
E. I have no surplus campaign funds; and
F. I have filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
I have used all reasonable diligence in preparing this statement. I have reviewed the statement an �o t best of my k edge the information contained
herein is true and complete. I certify under penalty of perjury under the laws of the State of Calif n� t at th f regliing i true a j d correct.
Executed on At L� t ( By i `
ATE ITY AND STATE SIGNATURE OF OfFICEHO ER OR CANDIDATE
FOR INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLITICAL REFORM ACT
State of California Fair Political Practices Commission
STATEMENT OF ORGANIZATION
Statement of Organization WHERETO FILE: sil
copy Date Stamp
Recipient Committee original
File and one co of this form with:
(Government Code Sections 84101- 84103) Secretary Political l Re D AND FILED
Division CEIVED ' g 91 Its
P.O. Box 1467 In th office of the Secretary of Stale For Official Use Only
� Oa mendment Sacra In ento. CA 95812 -1467 of the State of RIIIIie 405
JCL. Check box if an Amendment And, If applicable, file one copy of this form with:
Type or print in ink and enter I.D. number: OCT 1 5 996
The city or county officer, if a ny, who receives the
committee's original campaign disclosure I
SEE INSTRUCTIONS ON REVERSE # statements. UL40 olso
I Committee Information II Treasurer and Other Principal Officers
Date Qualified a5 NAME OF TREASURER
Committee (Month, D.Y. Yesd �'� `��_ Check box it not yet qualified I T x .
NAME OF COMMITTEE MAILING ADDRESS
hj,0 .� '/ ✓� /.9,0 — .�' �jy� � L CITY STATE ZIPCODE AREA CODE /DAYTIME PHONE
ADDRESS OF COMMITTEE (NOT P.O. BOX) NO. AND STREE
q 7i��Ctt� �/�12593 - 152/ 909- G 77 DS5</
�fpl�70 8Fi LOr/B NAME AND POSITION OF OTHER PRINCIPALOFFICER(S)
CITY STATE ZIP CODE AREACODE /PHONE NUMBER
L`( 9259 — G99 - �6 MAILING ADDRESS
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT -
THAN COUNTY OF DOMICILE
CITY STATE :ZIP CODE AREA CODE /DAYTIME PHONE
MAILING ADDRESS (IF DIFFERENT) NO.. AND STREET OR P.O.. BOX
x �9Z bLl/ Attach additional inform ation on appropriately labeled continuation sheets.
CITY STATE ZIPCODE AREA CODE/ PHONE NUMBER
C3. 4 '�, 909 - y9- �2�9
III Disposition of Surplus Funds You must specify what disposition will be made of leftover campaign funds, if any, at termination.
`TP,ec_ L lil_/ . Z--
IV Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I
certify under penalty of perjury under the laws of the State of California that the foregoing is true ani;�orrect.
Executedon Z 1'4- At / t�//17PG'G/LQ �G/. By _
D E CITY AND STATE SIGNA URE OF TREASURER
Executed on At By
DATE CITY AND SLATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR SLATE MEASURE PROPONENT
Executed on At By
DATE CITY AND STATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on At By
DATE CITY AND STATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
FOR INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLITICAL REFORM ACT
State of California Fair Political Practices Commission
i
i
� 4
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee " t
'3It
Type or print in ink
Page 2
NAME OF COMMITTEE _ I.D. NUMBER (IF AMENDMENT)
V Type of Committee Completing This Statement: rpM9t THE APPLICABLE SECTION(S). MORE THAN ONE CATEGORY MAY BE APPLICABLE TO YOUR COMMITTEE.
SEE-REVERSE FOR IMPORTANT INFORMATION AND DEFINITIONS OFTHE COMMITTEES LISTED BELOW.
Controlled Committee
• If this committee is controlled by one or more officeholder( s) or candidate(s), list the name of each controlling officeholder or candidate. Also list the elective office sought or held, and district
number, if any, for each individual.
• If thi s committee is controlled bToneorm orEOfficehold erfd or candidate(s) for part an office list the noliticalnaMLw ea ch officeholder or candidate is affiliated An officeholder or
candidate not holding or seeking a partisan office must indicate non- partisan.'
• If this committee is controlled by a state measure proponent, list the name of the state measure proponent. if this 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.
NAME CANDIDA E /OFFICEHOLDER/STATE MEASURE PROPONENT /COMMITTEE PARTY ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE)
Primarily Formed Committee I If primarily formed to support or oppose specific candidates ormeasur es, list the candidates or a resbelow:
CANDIDATE'S OFFICE SOUGHT OR HELD OR MEASURE'S JURISDICTION CHECK ONE
CANDIDATE'S NAME OR MEASURE'S FULL TITLE (INCLUDE BALLOT NO.OR LETTER) INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE
SUPPORT OPPOSE
SUPPORT I OPPOSE
General Purpose Committee
If not formed to support or oppose specific candidates or measures, check ONE box to indicate if this is a: ❑ CITY Committee or ❑ COUNTY Committee or ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
sponsored Committee Provide the name and address of the sponsor. If the committee has more than one sponsor, provide names and addresses on appropriately labeled attachment.
NAME OF SPONSOR: INDUSTRY GROUP OR AFFILIATION OF
SPONSOR:
ADDRESS OF SPONSOR: NO. AND STREET CITY STATE ZIP CODE
Broad Based Committee
If this is abroad based committee and wishes to make contributions to candidates in excess of the $2,500 contribution limit in connection with a special election, check the box below and enter the
date on or before which the committee qualified as abroad based committee. (If the committee is not abroad based committee, or does not wish to make contributions in excess of the $2,500 limit,
do not complete this section.)
❑ Check box if this is abroad based committee. Enter the date on or before which the committee qualified as abroad based committee:
(Month, Day, Year)
❑ Check box if this committee no longer qualifies as a broad based committee.
Statement of Or WHERE TO FILE: STATEMENT OF ORGANIZATION
Recipient Committee File original and one copy of this form with: Date Stamp IWlF {li
rr11 t-R tr�l
Secretary of State O �•. 11 f� !"'..
(Government Code Sections 84101- 84103) Political Reform Division
P.O. Box 1467 For Official Use Only
Amendment Sacramento, CA 95812.1467 7
y} Check box if an Amendment And, If applicable, file one copy of this form with: Kom OC 1 1 1996 1996 Ty or p rint In ink and enterl.D. number: The city or county officer, if any, who receives the
p ; - - .J i
96 �d3CJ committee's original campaign disclosure LZ
SEE INSTRUCTIONS ON REVERSE # 7 statements.
I Committee Information II Treasurer and Other Principal Officers
Date Qualified as NAME OF TREASURER
Committee (Month, Day. Year) ae7:�6 ❑ Check box if not yet qualified ,/J
Or COMMITTEE MAILING ADDRESS `J
cc y ��l n 6 �x .�Z✓
CITY STATE ZIPCODE AREA CODE /DAYTIME PHONE
ADDRESS OF COMMITTEE (NOT P.O. BOX) NO. AND STREE
, Ar ' 4 1- 70 4. klr &Ve NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S)
CITY STATE ZIPCODE AREA CODE/ PHONE NUMBER
j� 159 —G99- 1S� MAILING ADDRESS
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
vP !_ CITY STATE 0PCODE AREA CODE /DAYTIME PHONE
MAILING ADDRESS (IF DIFF NO.. AND STREET OR P.O.. BOX
x
CITY STATE ZIP CODE AREA CODE/ PHONE NUMBER Attach additional information on appropriately labeled continuation sheets.
92,50 --�r-sy 909- e y9- 2wz
• III Disposition of Surplus Funds You must specify what disposition will be made of leftover campaign funds, if any, at termination.
f
IV Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I
certify under penalty of perjury under the laws of the State of California that the foregoing is true an "orrect.
Executedon '`° At / ✓�/ylG�G �cA. By
Dy E CITYANDSTATE SIGNNA UREOf TREASURER
Executed on At By
DATE CITY AND STATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on At By
DATE CITY AND STATE SIGNATURE Of CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on At By
DATE CITY AND STATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FOR INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT Of 1977. SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLITICAL REFORM ACT
State of California Fair Political Practices Commission
Statement of organization STATEMENT OF ORGANIZATION
Recipient Committee j' Y
Type or print in ink
Page 2
NAME OF COMMITTEE _ I.D. NUMBER (IF AMENDMENT)
V Type of Committee Completing This Statement: C OMP TE THE APPLICABLE SECTION(S). MORE THAN ONE CATEGORY MAY BE APPLICABLE TO YOUR COMMITTEE.
S EVERSE FOR IMPORTANT INFORMATION AND DEFINITIONS O COM MITTEE S LI BELOW.
Controlled Committee
a If this committee is controlled by one or more officeholder( s) or candidate(s), list the name of each controlling officeholder or candidate. Also list the elective office sought or held, and district
number, if any, for each individual.
• a_ this rommitta issontcolle 6To^s or more officeholder(s) or ate(s) for partisan office list the political Party with which each officeholder or candidate is affiliated. An officeholder or
_candidate not holding or seeking a partisan office must indicate 'non-partisan.'
a If this committee is controlled by a state measure proponent, list the name of the state measure proponent. If this committee is controlled by more than one state measure proponent, list the
name of each state measure proponent.
a If this committee actsjointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME CANDIDA E/OFFICEHOLDER/STATE MEASURE PROPONENT /COMMITTEE PARTY ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE)
Primarily Formed Committee I If primarily formedto support oroppose specific candidatesor measur : es, list the candidates or a resbelow:
CANDIDATE'S NAME OR MEASURE'S FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CAN (INCLUDEODISTR S C O T NO. CITY OR COUNTY A APPLICAB EICTION CHECK ONE
SUPPORT OPPOSE
SUPPORT I OPPOSE
General Purpose Committee
�f not formed to support or oppose specific candidates or measures, check ON E box to indicate if this is a: ❑ CITY Committee or ❑ COUNTY Committee or ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored Committee I Providethe name and address of the sponsor. If the committee has more than one sponsor, provide names and addresses on appropriately labeled attachment.
NAME OF SPONSOR: INDUSTRY GROUP OR AFFILIATION OF
SPONSOR:
ADDRESS OF SPONSOR: NO. AND STREET CITY STATE ZIPCODE
Broad Based Committee
If this is a broad based committee and wishes to make contributions to candidates in excess of the $2,500 contribution limit in connection with a special election, check the box below and enterthe
date on or before which the committee qualified as a broad based committee. (If the committee is not a broad based committee, or does not wish to make contributions in excess of the 52,500 limit,
do not complete this section.)
❑ Check box if this is a broad based committee. Enter the date on or before which the committee qualified as a broad based committee:
(Month, Day, Year)
❑ Check box if this committee no longer qualifies as a broad based committee.
-} " 9u 3 0
3 STATEMENT OF ORGANIZATION
4Statement Or 3 WHERE TO FILE:
Reci pient Corhmittee File on PY in al and one co of this form with: Date Stamp
Reci pient of State AN FILED
(Government Code Sections 84101 84103) Political Reform Division in the ffice of the Secreipry of State - _ I
P.O. Box 1467 I D 1
Amendment Sacramento, CA 95812 -1467 the State of California
m
❑ Check box if an. Amendment And,Ifa applicable, of this form with EP Q 9 �g96 p
Type or prin t 1 Ink"- and enter I.D. number: or ny , OCT 11 9J6 I
y . _ The city or county officer, if any, who receives the
committee's original campaign disclosure
SEE INSTRUCTIONS ON REVERSE statements. BILL ONES, Secretary of State B
I Gimrrilttee'Information II Treasurer and Other Principal Officers
Date Qualified of NAME / TREASURER !/ '
Comm ;4p,L,,,;n,Dry,YnN �` Check box if not yet qualified �
AMROFCOMAMUFF
�f71777�✓Gt ��7T ���_ CITY STATE ZIPCODE AREA CODEIDAYTIME PHONE
ADDRESS OF COMMITTEE (NOTP.O.BOX)NO.AN SET
T ' `�
�4z 7U irir� /�� Cam. �iZS93 -oszl �io�- �7705
C�J yL NAME AND POSITION OF OTHER OFFICER(S)
CITY STATE ZIP CODE AREA CODE/ PHONE NUMBER
MAILING ADDRESS
COUNTY OF DOMICILE COUNT WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
r •'t•`. '•`• CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE -
AILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
, x 9z6 /
CITY "' STATE ZIPCODE t AREA CODE/ PHONE NUMBER Attach additional information on appropriately labeledcontinuatlon sheets.
spot t on of Surpl Fun S You must specify what disposition will be made of leftover campaign funds, if any, 4t termination.
IV Verification
1 have used all reasonable diligence in preparing this sta ement and to the best of my knowledge the information contained herein is true and complete. I
certifyynder penalty of perjury under the laws of the State of Ca lifornia that the foregoing is true and co d
Executed on 9 ' P - At /c/2�Grr�GF/ /� By
DATE _ CIIYANDSTATE IGNATURE Of TREASURER
Executedon At By
DATE CITY AND STATE SIGNATURE Of CONTROLLING Of IICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on At By
DATE CITY AND STATE SIGNATURE OF CONTROLLING Orr ICEHOLDER. CANDIDATE. OR STAIE MEASVRI PROPONENT
Executed on At By
DATE CITYANDSTATE SIGNATURE Of CONTROLLING OFFICEHOLDER CANDIDATE, OR STATE MEASURE PROPONENT
ION INFORMATION REEEMD TO BE PROVIDED 10 YOU PURSUANT TO THE INFORMATION PRACTICES ACT 01 1971, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS Of THE POLITICAL REFORM ACT
State of California fair Political Practices Commission j
7aieflllit of Organization STATEMENT OF ORGANIZATION
Recipient Committee
Type or print in ink
Paget
NAMEOFCOMMITTEE / ) / /� I.D. NUMBER (IF AMENDMENT)
V 'Type of Committ Compl This State ment: COMPLETE THE APPLICABLE SECTIONS MORE THAN ONE CATEGORY MAYBE APPLICABLE TO YOUR COMMITTEE.
'.' SEE REVERSE FOR IMPORTANTYNEOR ATION AND DEFINITIONS OF THE COMMITTEES LISTED BELOW.
ControlledCommlttee
a It thi4 committee Is controlled by one or more officeholder(%) or candidate(s), list the name of each controlling officeholder or candidate. Also list the elective office sought or held, and district.
+ . nsunW, If any, for each Individual.
paTttsan - oTflc , s epo ca partywt w Ic eechoNicehol er or candidate Is affiliated. An officeholder or
candidate not holding or seeking a partisan office must Indicate 'non-partisan.'
a If this committee is controlled by a state measure proponent, list the name of the state measure proponent. If this committee Is controlled by more then one state measure proponent, list the
name of each state measure proponent.
a If this committee acts jointly witha'Othercontrolledto mlttee, listthenameandIdentificationnumberoftheothercontrolledcommittee.
NAME O(CANDIDA . FFICEHOLDERWATE MEASURE PROPONENTICOMMITTEE PARTY ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE)
Prlro8dly Formed Cornmlttee . If primarily formed to support or oppose specific candidates ormeaslsces thecaandidatesor
CANDIDATE'S NAME OR MEASURE'S FULL TITLE (INCLU �E BALLOT NO.OR LETTER) CAND INCIUDE DISTRICT NOH CI AS AVPLICABLEICTION' ' cmcKOm
,sunoRT ono %!
SUPPORT cal
GenlMl PurpoSp_Commlttee
If not formed to support or oppose specific candidates or measures, check ONE box to indicate If this Is a: ❑ CITY Committee or ❑ COUNTY Committee or ' STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
S ons red Committee Provide the na a and address of the sponsor- If the committee has more than one sponsor, provide names and addresses on appropriately labeled attachment.
NAMEOE SPONSOR: INDUSTRY GROUP OR AFFILIATION OF
" - SPONSOR:' C1
ADDRESS OF SPONSOR: NO. AND STREET CITY STATE ZIPCODE ti•,•
broad Based Committee " Ei
If this is a broad bated committee and wishes to make contributions to candidates in excess of the $2,500 contribution limit in connection with a special election, check the box below and enter the
date on or before which the committee qualified as abroad based committee. (N the committee is not abroad based committee, or does not with to make contributions In excess of the $2,500 limit,
do not complete this section.) "
[j 'C heck bow If (his 14 broad bated committee. Enter the date on or before which the committee qualified as a broad based committee:
(Mont " ay, Year)
[� Check box If this committee no longer qualifies a +ablood based committee.
0
Statement of Or g anization WHERE TO FILE: STATEMENT OF ORGANIZATION
ReClplent Committee File original and one copy of this form with: Date Stamp
(Gb4emment Code Sections 84101 - 84103) Secretary of State
Political Reform Division
P.O. Box 1467 RECEIVED For Official Use Only
Amendment Sacramento, CA 95 81 2 - 1 46 7
T rintlnink ❑ Check box ifanAmendment And, if applicable, file one copy of this form with: SEP 0 51996
Ty p and enter I.D. number: The city or county officer, if any,who receives the
committee's original campaign disclosure CITY CLERKS DEPT.
SEE INSTRUCTIONS ON REVERSE # statements.
I Committee Information II Treasurer and Other Principal Officers
Date QUallfled as NAME 1 TREASURER
,Comm OAMEh, C LIF F. YnT) �Check box if not yet qualified
LAME OF COMMITTEE MAILING ADDRESS / l
j7 L CITY STATE 21P CODE . AREA CODE/DAYTIME PHONE
ADDRESSOF COMMITTEE (NOT P.O.BOX)NO.AN ST ET `- 5-
� 4Z 7 v �2�i�r� /� / '/G ! ' �J CCU. -,0 S - ,-- �05 ��7o�
C�� // C� NAME AND POSITION OFO HER PRINCIPAL OFFICER(S)
CITY STATE ZIP CODE AREA C PHONE NUMBER
/l Z MAILING ADDRESS
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
CITY STATE ZIP CODE AREACODE/DAYTIME PHONE
/lam i f
AILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZIPCODE j AREA CODE/ PHONE NUMBER Attach additional Information on appropriately label ldcontinuation sheets.
SpbS t on of Sur / plus Funds You must specify what disposition will be made of leftover campaign funds, if any, �t termination.
IV Verification
I have used all reasonable diligence in preparing this sta ement and to the best of my knowledge the information contained herein is true and complete. I
kertify penalty of perjury under the laws of the State of California that the foregoing is true and correct.
ExecutEdon 7 1 3 — At By
DATE OTY AND STATE IGNATURE Of TREASURER
Executed on At By
DATE CITY AND STATE SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE. OR STATE MEASURE PROPONENT
Executed on At By
DATE CITY AND STATE SIGNATURE Or CONTROLLING off ICEHOmE R. CANDIDATE, OR STATE MEASURE PROPONENT
Executedon At By
DATE CITY AND STATE SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT
FOR FFDORMATFON AEOUFRED to It PROVIDED TO YOU PINLSUANT 10 THE INFORMATION PRACTICES ACT Of 1917, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS Of THE POLITICAL REFORM ACT
State of California Fair Political Practices Commission
Statement of Org anization STATEMENT OF ORGANIZATION
Recipient Committee
Type or print in ink
vage 2
NAME OF COMMITTEE / /'� / I.D. NUMBER (IF AMENDMENT)
>ZI.C� � �
V Type Of Co mmittee Completi Thi State COMPLETE THE APPLICABLE SECTIONS MORE THAN ONE CATEGORY MAYBE APPLICABLE TO YOUR COMMITTEE.
SEE REVERSE FOR IMPORTANTYNF_OR AT ION AND DEFINITIONS OF THE COMMITTEES LISTED BELOW.
Controlled Committee
• If this committee is controlled by one or more officeholder( s) or candidate(s), list the name of each controlling officeholder or candidate. Also list the elective office sought or held, and district.
W number, If any, for each individual. j
tenor o ice o ersorcan idatesjfor partisan office, list the political party with which each officeholder or candidate is affiliated. An officeholder or
candidate hot holding or seeking a partisan office must Indicate 'non-partisan.'
• If this Comm lttel is controlled by astate measure propooent, list the name of the state measure proponent. If this committee is controlled by more than one state measure proponent, list the
name of each state measure proponent. -
• If this committee actilointly with another controlled co mittee, list the name and identification number of the other controlled committee.
NAME O CANDIDA FFICEHOLDER15TATE MEASURE PROPONENTICOMMITTEE PARTY ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE)
IqL,�et�T
IP Primadify Formed Committee if primarily formed to support or oppose specific candidates or measbres,_I the candidates or measures below:
iT CANDIDATE'S OFFICE SOUGHT OR HEELD OR MEASURE'S JURISDICTION
CANDIDATE'S NAME OR MEASURE'S FULL TITLE (INCLU �E BALLOT NO. OR LETTER) INCLUDE DISTRICT NO., CITY Oli COUNTY AS APPLICABLE cntcx ONE
SUPPORT 0`
SUPPORT OPPOSE
I
General Purpose Committee
- formed to support or oppose specific candidates or measures,check ONE boxtolndicate if this isa: ❑ CITY Committee or ❑ COUNTY Committee or ❑ STATE Committee
aROVIDE BRIEF DESCRIPTION OF ACTIVITY
Spoils t edConrif"Itteel Provide the rte a and addressof the sponsor. If the committee has more than one sponsor, provide names and addresses on appropriately labeled attachment.
NAME QESPONSOR: INDUSTRY GROUP OR AFFILIATION OF
SPONSOR:
ADDRESS OF SPONSOR: NO. AND STREET CITY STATE ZIPCODE
broad Based Committee
It this is a brood based committee and wishes to make contributions to candidates in excess of the 52,500 contribution limit In connection with a special election, check the box below and enter the
date on or before which the committee qualified as a broad based committee. (If the committee Is not abroad based committee, or does not wish to make contributions in excess of the 52,500 limit,
' do not complete this sectlon.) _ �/ � /��
0 Check box It this Is d broad based committN. Enter the data on or before which the committee qualified as a broad based committee:
❑ Check box It this committee no longer qualifies as a broad based committee. (Month sy,Year)