HomeMy WebLinkAbout2017-03-27 Statement of Facts - Public Financing Authority
State of California Secretary of State
STATEMENT OF FACTS
ROSTER OF PUBLIC AGENCIES FILING
(Government Code section 53051)
Instructions:
1. Complete and mail to: Secretary of State,
P.O. Box 942877, Sacramento, CA 94277-0001 (916) 653-3984
2. A street address must be given as the official mailing address or as
the address of the presiding officer.
3. Complete addresses as required.
4. If you need additional space, attach information on an 8½” X 11” page, one sided and legible.
New Filing Update
Legal name of Public Agency:
Nature of Update:
County:
Official Mailing Address:
Name and Address of each member of the governing board:
Chairman, President or other Presiding Officer (Indicate Title): __________________________________________
Name: __ Address:
Secretary or Clerk (Indicate Title):
Name: __ Address: ___________________________________________________
Members:
Name: _____________________________ Address: __________________________________________________
Name: _____________________________ Address: __________________________________________________
Name: _____________________________ Address: __________________________________________________
Name: _____________________________ Address: __________________________________________________
Name: _____________________________ Address: __________________________________________________
RETURN ACKNOWLEDGMENT TO: (Type or Print) _________________________________________
Date
NAME ⎡ ⎤
_________________________________________
ADDRESS Signature
CITY/STATE/ZIP ⎣ ⎦ _________________________________________________
Typed Name and Title
SEC/STATE NP/SF 405 (REV. 05/09)
(Office Use Only)