HomeMy WebLinkAboutLewis - Form 410_2025-01-24 Termination (SOS Copy)_RedactedStatement of Organization
Recipient Committee
Statement Type ❑ initial ❑ Amendment
0 Not yet qualified
or
0 Date qualification threshold met Date qualification threshold met
I.D. Number 1y-1 34 6S
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7AME OF COMMITTEE
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CITY
FULL MAILING ADDRESS (IF DIFFERENT)
COUNTY OF
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STATE ZIP CODE AREACODE/PHO
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Attach additional information on appropriately labeled continuation sheets.
Date Stamp
ECEIVED AND FIB D For Official Use Onl
Termination — See Part 511 the Office of the Y
of the State ofaforrl�aS to
Date of termination DEC 171014
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NAME OF TREASURER
STRE STATE ZIPCODE
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE
EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED) AREA CODE/PHONE
NAME OF PRINCIPAL OFF
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE
EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED)
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 Sta
Executed on 202A By ATRECEIVED
E SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on DATE By JAN 2 4 2025
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on DATE By SLO CITY CLERK
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 (October/2023)
FPPC Advice: advice0fppc.ca.E:ov (866/275-3772)
www.fpoc.ca.gov
Statement of Organization CALIFORNIA
Recipient Committee FORM 410
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAM � I.D. NUMBER
�,ic�a- S CMG 141 3 85
• All committees must list the financial institution where the campaign bank account is located and the person(s) authorized to obtain bank records.
NAME OF FINANCIAL INSTITUTION AND PERSON(S) AUTHORIZED TO OBTAIN BANK RECORDS AREA CCIDE/PHONE
ADDRESS OF FINANCIAL INSTITUTION CITY STATE 71P CODE
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Controlled Committee
• 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 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 CHECK ONE
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Nonpartisan
Partisan
(list political party below)
Nonpartisan
Partisan
(fist political party below)
Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) NAME OR MEASURES) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATES) 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 APPLICABLE) rucrr nuc
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410(actober/2023)
FPPC Advice: advlceRDfaoc ca.eov (866/275-3772)
www.fPPc.ca.eov