HomeMy WebLinkAboutCarlyn Christianson - Form 410 - Amendment - 03-04-2013'Statement of Organization Type or print in ink STATEMENT OF ORGANIZATION
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Recipient Committee ® :u 0
Statement Type ❑ Initial
Not yet qualified ❑ or
Date qualified as committee
1. Committee Information
Amendment
Lists I.D. number:
I�S5—I Gf(J
Date qualified as committee
(If applicable)
NAME )FCOMMITTEE ( 1 I )
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❑ Termination — See Part 5
List I.D. number:
MAR 07 2413
Date of Termination
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2. Treasurer and Other Principal Officers
NAME OF
7-r_ I -I F L`� rro ll
STREET
CITY STATE ZIP CODE
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STATE ZIP CODE AREA CODEIPHONE NAME OF ASSISTANT TREASURER, IF ANY
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STREET ADDRESS
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX /E -MAIL ADDRESS
C'CI1'1 )� „C�cE'c otter /l Cc /��
COUNTY OF DOMICILE COUNTY WHERE COMMIT I EE IS AU nve o- UIrreracrvI
THAN COUNTY OF DOMICILE
S�tl� L. s C?G�I� /�v tai n
Attach addifional infonnation on appropriately labeledcontinuation sheets.
CITY STATE ZIP CODE AREA CODE /PHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IFAPPLICABLE
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE /PHONE
3. Verification 'r - -
I have used all reasonable diligence in preparing this statement and to the best of my knowle ge t a information contained herein Is true and complete. I certify under penalty of
perjury under the laws of the State of Californiathat the foregoing is true and co
Executed on . L /-. d G'� j By
DATE \.__ 'TREASURER
Executed on `� I By
DATE 5 NATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on nnTF By SIGNATURE OF CONTROLLING `OFFICEHOLDER CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATF SIGNATURE OF COIJTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (January /05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
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4. Type of Committee Complete the applicable sections.
• 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 "non-partisan."
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME OF CANDIDATE/ OFFICEHOLDER /STATE MEASURE PROPONENT
ELECTIVE DISTRICT IF OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
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Non- Partisan
Non - Partisan
Listthe financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INST1ITUTION D AREA CODE /PHONE BANK ACCOUNT NUMBER
iSSIcn Grrlrv,lti�i,� y %`l Y1/< (
ADDRESS CITY STATE ZIP CODE
SGT in �l,oS 016 1`yo
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
FPPC Form 410 (January /06)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/273 -3772)