HomeMy WebLinkAboutDan Carpenter - Form 410 - Termination 01-04-2012Statement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ❑ or
Date qualified as committee
1- Committee Information
NAME OF COMMITTEE
Type or print in ink
❑ Amendment
List I.D. number:
f. —I
Date qualified as committee
(If applicable)
K --er fns S t-p G
ermination — See Part 5
List I.D. umber:
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Date of Termination
Date Stamp u I 'a
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JAN 08 2013
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2. Treasurer and Other
rincipal Officers
NAME OF TREASURER
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STREET
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CITY STATE ZIP CODE
CIL
MAILINGADDRESS (IF DIFFERENT)
OPTIONAL: FAX / E- MAILADDRESS
da N Ca r12 s L.Q 4.AWo . C C) &i,,
COUNTY OF DOMOtILE COUNTY WHERE COMMITTEE ISACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
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Attach additional information on appropriately labeled continuation sheets.
STATEMENT OF ORGANIZATION
• - AIA ,
I
:-or Official Use Only
(
STATE ZIP CODE
�
NAML OF ASSISTANT TREASURPR, IF ANY
^� /STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREACODE /PHONE
NAME OF PRINCIPAL OFFICER(S)
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREACODEIPHONE
3. Verification
I have used all reasonable diligence in preparing this statement and to the
/
DATE y
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
Executed on By
DATE IGNATU E OF CONTROLLING OFFICEHOLDER, ANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (April /2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Statement of Organization
STATEMENT OF ORGANIZATION
Type or print in ink Date Scam
Recipient Committee • - M M
Statement Type ❑ Initial
Not yet qualified ❑ or
I 1
Date qualified as committee
❑ Amendment
List I.D. number:
#
I I
Date qualified as committee
(If applicable)
1. Committee Information
NAME OF COMMITTEE
K p? l4er -Cntl S to G
STREET
AREACODEIPHONE
Ltt, s f 6vav
MAILING ADDRESS (IF DIFFERENT)
=ET ACBRInS (
FPPC Form 410 (April /2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
CITY STATE ZIP CODE AREACODE/PHONE
OPTIONAL: FAX/ E -MAIL ADDRESS
d1'., �� r��v7� • [ OsM
NAME OF PRINCIPALOFFICER(S)
COUNTY OF DOM ILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
STREETADDRESS (NO P.O. BOX)
�Sk LLit.
CITY STATE ZIP CODE AREA CODEIPHONE
Attach additional information on appropriately labeled continuation sheets.
3. Verification
I have used all reasonable diligence in preparing this statement and to the
OR STATE MEASURE PROPONENT
Executed on By
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROP NENT
FPPC Form 410 (April /2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)