HomeMy WebLinkAboutLewis - Form 410_2024-12-04 Termination_RedactedI lnniat
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O oate qualification threshold met
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NAME OF PRINCIPAT OFFICER(5]
€MAiI ADDRESS OF A5SISTANT TREASURER (REQUIRED)AREA COD€/PHONE
sTREET ADDRTSS {NO P,O, 8OX)STAT I.ZIP CODECITY
NAME OF ASSISTANT TREASURER, IF /\NY Jao-"TJDo,I+C,J \covl fl5-8tr,
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I Amendment Termination - See For Official tjse Only
I
)-SLO CITY CLERK
Date of termination
DEc 0 47074
Date qualification threshold met
_/ /
1. Committee lnformation 2. Treasurer and Other Principal Officers
3. Verification
Statement of Organization
Recipient Committee
Statement Type
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 cerlrfy under
penalty of perjury under the laws of the State the
Executed on
Executed on
Executed on
Executed on
le 4 By
By
By
By
ASSISTANT TREASURER
SIGNAI tJRt Ofi CON I ROLLI NG Ol FlCe HOLDE R, CANOIDAI [, OR S IAI t MtAsU ah PROPON hN 1
SICNA] URI OF CONTROLLIN€ OFFICIIlOLDIR, CANDIDATT, OR STATI MIASURT PROPONTN]
FPPC Form 410 (October/2023)
FPPC Advice: advice@fooc.ca.sov (866 | 27 3-377 2l
www.fooc.ca.qov
SIGNATURL CF CONTROTLING OFFICEHOI.DER, CANDIDAl€, OR STATT M€A5URE PROPONENT