HomeMy WebLinkAboutBENHAM SUE 410 tatement of Organization
Recipient Committee
Statement Type ~lnitlal
Notyetqualitied [] or
Type or print in ink
[] Amendmenl [] Termination - See Part~0 ~[
List I,D, number: List I,D, humbert
# #
Date qualified as committee Date qualified as committee
__Y I
Date ol TerminaUon
Dale Stamp
STATEMENT OF ORGANIZATION
For Official Use Only
1. Committee Information 2. Treasurer and Other Principal Officers
NAMEOFCOMMI/~FEE NAME OF TREASURER
STREET ADDRESS [NO P.O. BOX) CIW STATE
CIW STATE ZiP CODE AREA ODD.PHONE NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS (iF DIFFERENT
OPTIONALt'F~ / E-MAiL ADDRESS-
COUN~ OF DOMICILE
c%W.H R: ? D%q ,lIE IS ACTIVE ,F D,"PE"ENT
Attach additional information on appropriately/abe/ed continuation sheets,
ZIP CODE
AREA CODE/PHONE
MAILING ADDRESS
Ci~¢ STATE ZIP CODE AREA COD~*PHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODEIPHONE
3. Verification
! have used all ressonab[e diligence in preparing this statement and to the
perjury under the laws of the State of California that the foregoing is true
Executed on
O. 6 ' ~ATE
Executes on
OATE
e the information contained herein is true and complete. I cedify under penalty of
OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
CONTROLLING OFFICEHO[eER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 41i0 (8/99)
For Tech~ical Assistance: 916/322-5660
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMIT[EE NAME
4. Type of Committee complete the applicable sections,
· List the name of each controlling officeholder, candidate, or state measure proponent.
distdct number, if any, and the year of the election,
,, List the political par[y with which each officeholder or candidate is affiliated or check "non-padisan."
· If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
STATEMENT OF ORGANIZATION
LD. NUMBER
If candidate or officeholder controlled, also list the elective office sought or held, and
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONEN¥
ELECTIVE OFFICE SOUGHT OR HELD
NCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF ELECTION
~o0~
PART?
I~on-Partlsan
[] Non-Partisan
· List lhe financial instilution and the disposition of surplus funds (controlled "candidate election" committees only)
NAM E'"=~ ~ ~1 N A-~'~AL/N STITUTION
ADDRESS CITY
AREA CODE/PHONE
STATE ZIP CODE
AREA CODE/PHONE D~SPOSITiON OF SURPLUS FUNDS
DATE OPENED
i~7.~/7/P'~ ~F'.~ le/;~7/~t/IFJ;~ll Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDAFE(S) NAME OR MEASURE(S) FULL TITLE I~NCLUDE BALLOT NO. OR LE~-ER)
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDIC'rtON
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT I OPPOSE
SUPPORT 0P~OSE
FPPC Form 410 (8/99)
For Technical Assistance; 916,'322-5660