HomeMy WebLinkAboutShoresman - Form 410 - 2023-02-09_Termination_RedactedStatement of Organization
Date Stamp
CALIFORNIA
Recipient Committee
. 410
Statement Type ❑ Initial ❑ Amendment
® Termination —See Part
RECEIVED
M
For Official Use Only
❑ Not yet qualified
FEB 0 9 2023
or
0 Date qualification threshold met Date qualification threshold met
Date of termination
SLO CITY CLERK
I
02 / 06 / 2023
I.D. Nube1446628
III! III III 1 1111111 Pill III I •�Shor�esman
- • •
•- OfficersNAME
OF COMTTENAME
OF TREASL''nER
Vote Michelle for SLO City Council 2022
Dorothy Hines
STREETA
CITY
STATE
ZIP CODE AREA CODE/PHONE
Nipomo
CA
93444
CITY STATE ZIP CODE AREA CODE/P :C1C
NAME OF ASSISTANT TREASURER, IFANY
San Luis Obsipo CA 93401 805-550-2795
FULL MAILING ADDRESS (IF DIFFERENT)
STREETADDRESS NO P.O. 4011
E-MAIL ADDRESS (REaV[REO)/ FAX (OPTIORAQ
f.:Tv
SWE
ZJP CODE AREA COVVPHONE
michelleshoresman @grnail.com
COUNTY OF DOMICILE JURISIDIMON WHERE COMMITTEE IS ACT V E
NAME OF PRINCIPAL OFFICER(S)
San Luis Obispo City of San Luis Obispo
Michelle Shoresman
5TREETADDRESS INC P.O. SOXI
Attach additional information on appropriately labeled continuation sheets.
CITY
STATE
ZIP CODE AREA CODE/PHONE
3. Verification
San Luis Obispo
CA
93401
1 Ffdve used ail redSonaole autgence sn prepannI
penalty of perjury u [[er t e laws of the State of
Executed on J By
D rE
Executed on By —M
qTE
Executed on
DATE
awreage the Intormation contained herein i; true and complete. I certify under
correct.
By
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 (August/2018)
FPPCAdvice: advice@fppc.ca.eov (866/275-3772)
www.fppc.ca.eov