HomeMy WebLinkAboutMarcia Nelson - Form 410 - Termination - 01-28-2009TY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS (IF DIFFERENT) j\// A
) -
OPTIONAL: FAX/ E -MAIL ADbRESS
Statement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ❑ or
_ I I
Date qualified as committee
Type or print in ink
❑ Amendment
List I.D. number:
Date qualified as committee
(if applicable)
1. Committee Information
NAME ,OF,nCOMMITTEE ��� sV�
V
STREET ADDRESS (NO P.O. BOX) n
,
Termination — See Part 5 in
List I.D. number:
Date of Termination
Date Stamp
,EIVED Ald® -
office of the Secretary
of the State of Ca;rfoff
.JAN 3 0 2009
DEBRA EO W E
Secretary
2. Treasurer and Other Principal Officers
STATEMENT OF ORGANIZATION
RECEIVE
FEB _ 7009
LO CITY CUER
NAME OF TREASURER
STREET ADDRESS V
CITY STATE ZIP CODE AREA CODE/PHONE
STREET ADDRESS
CITY
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
L OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
3. Verification
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 la s of the State of California that the foregoing is true andeprAct.
Executed on � �- By - �-
DATE SIGNATURE OF TREASURER OR ASS ISTANT TREASURER
Executed on 07 By
OR STATE MEASURE PROPONENT
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/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
CO
Page 2
cl A - AJ
4. Type of Committee Complete the applicable sections.
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 "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 OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
M
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER
s^
ADDRESS �
� 2 � J V 01
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
SUPPORT IOPPOSE
SUPPORT I OPPOSE
FPPC Form 410 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)
Statement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ❑ or
I f
Date qualified as committee
1. Committee Information
Type or print in ink
❑ Amendment
List I.D. number:
�JI
Date qualified as committee
(If applicable)
NAME OF COMMITTEE
kc 11leL
STREET ADDRESS D P.O. BOX) ,
y J9 N L-U if L
MA) C, ADDRESS (IF DIFFERENT)
OPTIONAL: FAX /E -MAIL ADDRESS
STATE ZIP CODE AREA
/1)00 , I"/t .. 03
® Termination — See Part 5
List I.D. number:
�.
Date of Termination
Date Stamp
ECE-HI V
FEIS 0 2009
SL® C1 e Y CLER';
2. Treasurer and Other Principal Officers
NAME OF TREASURER
CG,4
STREET ADDRESS
STATEMENT OF ORGANIZATION
Oft W Use Only
t--,4NZIll /,'� r6-7
CITY STATE ZIP CODE AREA CODE /PHONE
NAME OF ASSISTANT TREASURER, IF ANY
AJ
STREET
fi / CITY STATE ZIP CODE AREA CODEIPHONi
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFEREN I
THAN COUNTY OF DOMICILE
Attach additional information on appropriately labeled continuation sheets.
NAME AND 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 contained herein is true and complete. I certify under penalty of
perjury under the laws of the State of California that the foregoing is true a
Executed on 112 By
DATE
Executed on �/ iTl DA By
Executed on
DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING 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
STATEMENT OF
Page 2
LVIV {Mt111CC IYA {v {G � �J
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.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATEIOFFICEHOLDERISTATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION AREA CODEIPHONE BANK ACCOUNT NUMBER
4 %E - t?Ac,& Oo*T 2PrNi�-- Pos- _�-Yy -72o6 I
CITY STATE ZIP CODE %
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) CHECK ONE
OPPOSE
FPPC Form 410 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)