HomeMy Public PortalAboutForm 410
Statement o. rganization
Recipient Committee
Type or print In Ink
Statement Type
o Initial
Not yet qualified 0 or
o Amendment
list 1.0. number:
o Termination - See Part 5
List 1.0. number:
For OIricial Use Only
STATEMENT OF O~. .IZATION
Date Stamp
CALIFORNIA 41 0
FORM
tECE!VED
C 7 2005
#
# /.2 7.2 &-<- 9
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Date qualified as committee
I I
Date qualified as oommittee
(Ifappic;abte)
7 I .2 ~- 1...i2L
/ Date of Termination
1. Committee Information
NAME OF COMMITTEE
~L
-/;,r
CITY eCJOVClk-
L FIe/!
STREET ADDRESS (NO P.O. BOX)
t 10 C/l/J,e"-~>70v
2:;)J((}/vc;-
CITY
<:!L-ArI?En?oJ'J'T
STATE
01
ZIP CODE
<7/7'1
Af\.EA COOEIPHONE
(1a9/ {.24/-.n 77
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX.J E-MAIL ADDRESS
COUNTY OF DOMICILE
COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICilE
ANach additional information on appropriately labeled continuation sheets.
2. Treasurer and Other Principal Officers
NAME OF TREASURER
PAr }//lu/JuCOc"l/i2.
STREET ADDRESS
2 <120 N. HI"'.8c-s
Al/J;,v ~
STATE ZIP CODE
AREA CODE/PHONE
(Pc<J)O";-.3377
CITY
C'LA.t'E r/?O-vT
NAME Of ASSISTANT TREASURER, IF ANY
/ ETlFI2- S CAuA
STREET ADDRESS
C/-I '1/7/1
(;/0
CITY
L'HAk'LES70A/
De,ldO
STATE ZIP CODE
AREA CODE/PHONE
(9cY'J )C2L - 0.28
CLP,<'-E/>JO~ C!A '7/71/
NAME AND POSITION OF OTHER PRINCIPAl OFFICER(S), IF APPliCABLE
MAILING ADDRESS
CITY
STATE
ZIP CODE
AREA CODElPHQNE
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 peQally of
perjury under the laws of the State of California that the foregoing is true and correct.
a~~
- " OF TREASURER OR ASSISTANT TREASURER
51 TURE OF C TROlLING OFFICEHOlDER, CANDIDATE. OR STATE MEASURE PROPONENT
Executed on
12-~-CJS
DATE
h!7/ur
DATE
By
By
Executed on
Executed on
By
SIGNATURE OF CONTROlLING OFFICEHOlDER, CANDIDATE. OR STATE MEASURE PROPONENT
DATE
Executed on
By
SIGNATURE OF CONTROLLING OFFICEHOlDER, CANDIDATE, OR STATE MEASURE PROPONENT
OATE
FPPC Fo"" 410 (Jan/Ol)
FPPC Toll-Fr.. Helpline: 866/ASK-FPPC
Statement Of Organization
Recipient Committee
STATEMENT OF 0.. _nNIZATION
INSTRUCTIONS ON REVERSE
CALIFORNIA 410
FORM
COMMITIEE NAME
...A L
LElr;/I
;;.
r
1.0. NUMBER
{'IT'
elL-
/.2 7..2".2
4. Type of Committee Complete the applicable sections.
Controlled Committee
. List the name of each controlling officeholder, candidate, or slate 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
o Noo-Partisan
o 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 BANK ACCOUNT NUMBER
fJ'J' - 3L/'.z - 5733 cJ57ft c::s.?%
fJrr .sA;.)..!.. 4 ITuSr
ADDRESS
CITY
STATE
ZIP CODE
3/3
WFST
rOorhl/LL-
BLI/~
C! LA-€' E/hOA./T
C/l.
'7/7//- .27/0
Primarily Formed Committee
Primarily formed to support or oppose specific candidates or measures in a single election. Ust below:
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY. AS APPLICABLE)
I "-=r~'
SUPPORT OPPOSE
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
FPPC Fonn 410 (Jan/Ol)
FPPC TolI-Free Helpline: 866/ASK-FPPC
.. .-
Statement of Organization
Recipient Committee
STATEMENT OF ORGANIZATION
INSTRUCTIONS ON REVERSE
CALIFORNIA 410
FORM
COMMlTIEE NAME
E/64 1'0/ (! (/
4. Type of Committee (Continued)
(JC;UNe /L-
1.0. NUMBER
/2 :.2 "-2
General Purpose Commlltee
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
EI CITY Committee 0 COUNTY Committee 0 STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored Committee
List additional sponsors on an attachment.
NAME OF SPONSOR
INDUSTRY GROUP OR AFFilIATION OF SPONSOR
STREET ADDRESS
NO. AND STREET
CITY
STATE
ZIP CODE
Small Contributor Committee
o
I I
Date qualified
Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a small
contributor committee on January 1, 2001, enter 1/1101.
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer andlorcandidate, officeholder, or proponent certify that all of the following conditions have been met:
This committee has ceased to receive contributions and make expenditures;
This committee does not anticipate receiving contributions or making expenditures in the future;
This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
This committee has no surplus funds; and
This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
-- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to
Government Code Section 89519.
Additional filing obligations will be incurred if, after terminating, the committee receives or spends any funds, or receives the forgiveness of a loan,
repayments of loans made to others, or any other receipts.
FPPC Form 410 (Jan/Ol)
FPPC TolI-Free Helpline: 8661ASK-FPPC