HomeMy WebLinkAboutJOHNSON 410
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Statement of Organization
Recipient Committee
STATEMENT OF ORGANIZATION
1YPe or print In Ink
DaI8 Stamp
CALIFORNIA 41 0
FORM
For Official Use Only
Statement Type ~ Initial
Not yet qualified 0 or
o Amendment
list 1.0. number:
o Termination - See Part 5
list 1.0. number:
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Date qualified as committee
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Date qualified as committee
(If applicable)
1 1
Date of Termination
1. Committee Information
NAME OF COMMITTEE
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EJ. pIc raw ~ tJ,A/ ~ ~~ "'" ~. #~ Q;.
STREET AODRESS (NO P.O. BOX)
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CITY STATE
~
CITY
STATE
ZIP CODE
AREA CODElPHONE
OPTIONAL: FAX I E-MAIL ADDRESS
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
COUNTY OF DOMICILE
~r-N
COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
MAILING ADDRESS
CITY
STATE
ZIP CODE
AREA CODElPHONE
Attach additional information on appropriately labeled continuation sheets.
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
pe~ury under the laws of the State of Califomia that the foregoing is true and correct.
Executed on J- - z. 3 -Ij " By ~ 7~""-~4-/"'-
DATE ",c;? SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on .s- - ~l- ') - <1 eR By' ~:::?-..--~....... .
DATE OF CONTROLUNG OFFICEHOLDER, CANDIOATE, OR STATE MEASURE PROPONENT
Executed on
DATE
By
SIGNATURE OF CONTROLUNG OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
DATE
FPPC Form 410 (JanuarylO5)
FPPC Toll-Free Helpline: 8661ASK.FPPC (866/275-3772)
Statement of Organization
Recipient Committee
STATEMENT OF ORGANIZATION
INSTRUCTIONS ON REVERSE
CALIFORNIA 41 0
FORM
ge
I.D. NUMBER
COMMITTEE NAME
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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
<j? V S 5Jt:: J I -::.f;~.L. ;.J So 18' Non-Partisan
"..J C/ -ry Ct? (.JA" C~ ~_ - /...VA- ~b :5 ~,,'
o Non-Partisan
. List the financial instiMion where the campaign bank account is located (controlled "candidate election" committees only)
AREA CODElPHONE
BANK ACCOUNT NUMBER
NAME OF FINANCIAL INSTITUTION
<",~7 d. /;~~' ;../. A.
ADDRESS
F
.
Primarily Formed Committee
Primarily formed to support or oppose specific candidates or measures in a single election, Ust 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
IH'-I-
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FPPC Form 410 (JanuaryI05)
FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772)