HomeMy WebLinkAboutBENHAM 410 TERMINATION 1/31/13Statement of Organization y
Recipient Committee
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qualified as co
Date mmittee Datqualified as committee Date of Termination
(If applicable)
I Committee Information 2:
NAME OF COMMITTEE
Ccmro ►-f }ee To- E)ect�Sve &,o xy -rte
STREET ADDRESS (NO P.O. BOX)
FAX / E -MAIL ADDRESS
COUNTY OF DOMICILE
WHERE COMMITTEE IS ACTIVt
Attach additional information on appropriately labeled continuation sheets.
TREASURER
Date Stamp
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13 JAN 31 AN 8 44 ;�, tE f 5Y
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(_ERK FEB 0 1 Z03
DEBRA (01 EN
State
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STREET ADDRESS (NO P.O. BOX) I
CITY STATE ZIP CODE AREACODE /PHONE
NAME OF PRINCIPAL OFFICERS)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
3. Verification
I have used all reasonable diligence in prepari 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 5 e liforni tat the fore oing is true and correct.
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Executed on 1 r BY
DATE SIGNATURE DF TREASURER OR ASSISTANT TREASURER
1�
Executed on ' + By
DATE tIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE,OR STATE MEASURE PROPONENT
Executed on
DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONT ROILING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (Dec /2012)
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