HomeMy Public PortalAboutForm 410 TerminationStatement of Organization
Recipient Committee
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~Terminatlon -See Part
l)st LD. number:
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Date of Terrttinatian
1. Committee information
2.
NAME OF COMMITTEE
CDA~.r?7 bXJ -~ ~ 2..E S t~-.~~ ~'-c.~'~-Cn1.D~..r'~S
STREET ADDRESS (Np P.O. I~OX)
GTY STATE ZIP CODE AREACODE/PHONE
C~ L/-~~¢-Er'1 oM' C}} °J_! '1 / 1 ~ 09 -Io25-,
MAtUNG ADDRESS (IF
OPTIONAL• FAXlE-MAIL ADDRESS
STATEMENT OF ORGANIZATION
Date Stamp ~ •
:CEIVEO ANt~~ ~~~
pNISION • '
p~ SECREtApY ~ g-fa'fE
For Otllc;lal Use OMy '
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Bit. ~O~s ~saT -
s=GRET'AFiY ~.
Treasurer and Other Princtpal`~Kicers
NAME OF TREASURER
(r_A~~i ~awr~o~n) G 1[_
MAM.INO ADDRESS
l03~ Gi4-~y~~ D~
CITY STATE ZIP CODE ARi=AC~OE/PfiONE
~~~moNT ~-R ~t I '7! 1 X09- ~-s3 ~.
NAME Of ASSISTANT TREASURER, IF ANY
CITY STATE ZIP CODE AREA CODE/PHONE
NAIAE AND POSITION OF OTHER PRINCIPAL OFFICER(S). IF APPLICA9LE
COUNTY OF DOMICILE ~ COUNTY WHERE COMMITTEE IS ACTIVE iF DIFFERENT
LDS ~ G ~ f TF1AN COUNTY OF DOMICILE
ArteCh Bd~Or1a1 htrOrrnad'orl txl efpprtspristelyletyeled oCrrtiRtWliOn sheBts.
MAILING At>pRESS
CITY STATE ZIP CODE AREA COOEJPI~ONE
3. Verification
i have used all reasonable diligence in preparing this statement and to the best of my knowledge the infomnation contained herein fs true and complete. I certify under penalty of
perjury udder the laws of the Stalls[ of California Meat the foregoing is true and~co}rrect. /) J~ ~ 1/ - ~~
Ext3cvtedon ,42t~v~_~ l ~T , ~~ By _ L~.(_~ ~-P ~1 ~ ~'.c~c. ~~~C~J ~1~~
~J ATE SGNATURE OF TREASURER OR ASSISTANT TREASURER
EX9CUted On ~/
~~ l~CiNATUr~ OF CONTROLLNG OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Execultjd orl gy
DATE SIGNATI,JRE OF CONTROUJNG OFRCEHOLDER. CANDIDATE. OR STATE MFJ1SlJRE PROPONENT
F_xecvted on t3y .
DATE SIGNATURE CONTROWN(IOfFICEMOLDER.CANpIDATE, 1A EMEASUf~PRDPONENT
FPPC Form 41p (B/99j
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