HomeMy WebLinkAboutPapp - Form 410 - 2022-08-25_RedactedStatement of Organization
Recipient Committee
Statement Type initial ❑ Amendment
n Not yet qualified
or
(Date qualification threshold met Date qualfication threshold met
Committee1. I.D. Number
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NAME OF COMMITTEE
'POL f f 'Q0 --r- %(!' CA/ (-0 iti.-u- 2-022,
UIT STATE ZIP CODE
FULL MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
(IA-A5 (1) ��1.0 1C-41 4 �001 L'111�. C)
Termination — See Part 6
Date of termination
NAME OF TREASURER
jPHONE NAME OF ASSISTANT TREASURER, IF ANY
7�16 y Sou t'�L�
vt LLL:�
NAME OF PRINCIPAL OFFICERS)
STREET ADDRESS (NO P.O.
Attach additional information on appropriately labeled continuation sheets. I
CITY
Date Stamp
For official Use only
STATE a ZIP CODE G AREACO
STATE ZIP CODE AREA CO
5 e +01
STATE ZIP CODE
1 have used all reasonable diligence in preparing this statement and to the of y knowledge the information oontained herein is true and complete. I certify under
penalty of perjury under the laws of the State of Califor
Executed on CSC Z� By_ �����
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Executed on 2 J A f i ta 22 gy
DATn F SIG TLIREOFCO INGOFFEC R,CANDIDATE, OR STATE MEA5VP.FFRO PCNENT AUG 2 5 2022
Executed on By
DATE SIGNATURE O NTROU.ING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT O S CITY C 1 ": Q
Executed on BY
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DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advicel®fooc.ca.sov (866/275-3772)
www.fooc.ca.eov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINAN0ALINSTITUTION AREACODE/PHONE
ADDRESS CITY
75 S,0-44( <��v, L,,,;
BANK
ATE ZIPCODE
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.
Page 2
I.D. NUMBER
• List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." Stating "No party preference" is acceptable
• 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 YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECKONE
r— /1-ID ,-7
re.
IL 'A
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) NAME OR MEASURES) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
IF A RECALL, STATE "RECALL IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO.. CITY OR COUNTY. AS APPLICABLF)
party
CHECK ONE
'ORT OPPOSE
ORT OPPOSE
FPK Form 410 (August/2018)
FPK Advice: advice@fooc.ca.gov (866/275-3772)
www.fooc.ca.gov