HomeMy WebLinkAboutVEREEN 410 TERM 7/31/13Statem _ A of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet quafified ❑ or
❑ Amendment
List I.D. number:
Date qualified as committee Date qualified as committee
Of applinble)
NAME OF COMMITTEE
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Termination — See Part 5
List I.D. number:
#
3
Date of Termination
STREET
MAILING ADDRESS (IF DI
FAX / E-M.AIL ADDRESS
(
COUNTY OF DOMICILE I JURISDICTION WHERE COMMITTEE IS ACTIVE
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Attach additional information on appropriately labeled continuation sheets.
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Date Stamp
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in th office of the Secretary of State
of the state of Caiffomia 2013
AUG 05 2013 1
NAME OF TREASURER
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STATE ZIP CODE AREA CODE /PHONE
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NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX.)
CITY STATE ZIP CODE AREA CODE /PHONE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
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 perjury under the laws of the State of ornia that the forego' is and correct
Executed on By
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ATE �7 SIGNATURE OF TREASURER OR ASSISTANT TREASURER
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Executed on �— — 01 ' By
CAT SIG URE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CO NTAO LLI NG OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
FPPC Form 410 (Dec /2012)
FPPC Advice: advice @ fppc.ca -gov (866/275 -3772)
www.fppc.ca.gov
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