HomeMy WebLinkAboutHarmon, Heidi - Form 410 - 08-04-16 - Initial StatementStatement of Organization
Recipient Committee
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Statement Type YJ,Initial
❑ Amendment
Not yet qualified or List I.D. number:
1,
NAME OF COMMITTEE
Date qualified as committee Date qualified as committee
(If applicable)
14 e t p► 4a -c v o n -Fuv M" o r 01 1p
❑ Termination — See Part 5
List I.D. number:
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREACODE/PHONE
Save Lit i s Obi S o
MAILING ADDRESS (IF DIFFERENT) 11
C'2i;NTY OF DOMICIL
Owl W i S 0 (o 1 S e
WHERE COMMITTEE 15 ACTIVE
Attach additional information on appropriately labeled continuation sheets.
Date of Termination
Date Stamp
RECEIVED
AUG 04 2016
I SL0 CITY CLERK
2. Treasurer and other Principal c-ers
NAME OF TREASURER
K.A�ie ��Ik�r
For Official Use Only
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
fan 5 Obi o C-4-Alg3LI05 -
NAME OF ASSISTANT TREASURER, IF ANY
Hett>i �A cu-y-v",n
STREET ADDRESS (NO P.O. BOX}
CITY STATE ZIP CODE AREACODE/PHONE
Sah �u�S ��i C) C14 ���UO '
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE AREA CODE/PHONE
. Verification -
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. 1 certify under
penalty of perjury underthe laws of the State clt CaIJfgmia
t e foregoin is true and correct.
Executed on By
DA
DAT€ OVFICEHOLDER, CANDIDATE, OR STATE M ASURE PROPONENT
Executed on By
DATE
Executed on
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA
Recipient Committee ill1 : „ 411
INSTRUCTIONS ON REVERSE
Page 2
Cc]MMIITEE NAME LD NUMBER
�/e /Di Howm ul - ,r Maw/ - aol t
• All committees must list the financial institution where the campaign bank account is located.
l
NAME OF FINANCIAL INSTITUTION
Gc SCS oar CODE/PHONE BANK ACCOUNT NUMBER
WS'. 5414 % 2 0o ) em
AREAADDRESS CITYSTATE ZIP CODE
rr 5-i- S 0- VA lac c;t s i
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 "nonpartisan"
• 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
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION
Re'l-PI L-a(11fV�
Ma\-fOr
20(LV
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)
PARTY
San
Nonpartisan
CHECK ONE
SUPPORT OPPOSE
SUPPORT
FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov