HomeMy WebLinkAboutCarlyn Christianson - Form 410 - Initial Statement - 02-21-2013Statement of Organizati ®n
Recipient Committee
Statement Type •Initial `!
Not yet qualified Y or
Date qualified as committee
1. Committee Information
Type or print In ink
❑ Amendment
List I.D. number:
Date qualified as committee
(If applicable)
NAME OF COMMITTEE
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51 KttI ADURtCb lrvu Y.U. ovn/
❑ Termination —See Part 5
List I.D. number:
I I
Date of Termination
7
MAR 0 7 20,13
Cl.. =?. ,
2. Treasurer and Other Principal Officers
NAME OF TREASURER
CITY STATE ZIP CODE AREACODE/PHONE
(;1 'kV-' WI5 f/)lsro cA 01,3461
OPTIONAL: FAX /E- MAILAUUKh6b
(2G {I'//lI pc 0, 011. (&M
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
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Attach additional information on appropriately labeled continuation sheets.
STREET ADDRESS
c%CT..i <.. 4._- ,liCd
NAME OF ASSISTANT THE
STREET ADDRESS
STATEMENTOF ORGANIZATION
(If" it %' o/' ' /.
CITY STATE ZIP CODE AREA CODE /PHONE
NAMEAND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE /PHONE
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information,coptained herein
perjury under the laws of the State of California that the foregoing is true and correct.
i ar
Executed on :=
DATE �.
e
DATE o ...,+ .., ..,.. �,.- I.
and complete. I certify under penalty of
Executed on By
DATE 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 (January/06)
FPPC Toll -Free Helpline: 666 /ASK -FPPC (8661275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
7
CUM rl TEE NAME I.D. NUMBER
Ckd � Cl�r. �. .� Ct1�y Cc�l�cf�I a 13
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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, 9 any, and the year of the election.
• List the political party with which each officeholder or candidate is affiliated or checl( "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 ELECTISTRIC NUMBER AP HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
r
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Non- Partisan
Non - Partisan
® List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE I BANK /ACCOUNT NUMBER /
ADDRESS r CITY STATE ZIP CODE
✓�' / / ✓� ,..i �'C ..i.�l.ia I'V9 r:A,r• (_�'�<' Il Ji �Cli
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME ORMEASURE(S) FULLTITLE (INCLUDE BALLOTNO. OR LETTER) CANDIDATE(S) OFFICESOUGHTOR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
FPPC Form 410 (January/051
FPPC Toll -Free Helpline: 866 1ASK -FPPC (866/275 -3772)