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HomeMy WebLinkAboutGOH 410 INITIAL 3/7/16— Skltement of Organization Recipient Committee Statement Type 0Initial 16 APR 14 P; 1"Idifiatl 11(TA ❑ Amendment ❑ Termin:e,' un LD. number Uot l D. number [6116 li Date qualifies as committee Date qualifieIRM..) ittee In.PdNapel Karen Gain for Mayor 2016 bateof Termination Attach additional information on appropriately labeled continuation sheets. Shawn Kell oa*SGmp 116s't 9GIC11 etle ta it/ED AND FILED ce MAR 14 2016 oflhea;zM%C Hof State MAR 23 2016 STREET ADDRESS (NO P.O. 60M1 STREET ADDRRSa (NO PO. ROT) CITY STATE ➢P CODE ARIA CGLUFFONE NAME OF PRINCIPAL OFFICERS) STREET ADDRESS IND PO, Mo CITY .1 IF .BE AREA[DOEryxOryE 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 C li omia that a forego' g is and correct. ExecNedon 0310712016 By 03/07/20166 n^ n ^ T"EAEDRERORAUISraryrTREAEGRER a Exerea On By �F ARGEC ERecutedon Executed On By SIGNATURE OF CONTROLLING CrrCGHOLDER CANDIDATE OR STATE MEASURE PROPONENT By SGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Farm 410 (Jan /2016) FPPC Advice: adNe @h M.w.gw)866/2753772) www.fpPC...gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Karen Gob for Mayor 2016 All Committees mug list the financial Institution where the Campaign bank account Is lammed. Valley Republic Bank ADDRESS STATE ZIP CODE • 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. R List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." F If this Committee acts jointly with another controlled committee, list the name and identification number of the other controlled Committee. NAME OF"N010ATE /OFFICENOLOER/STATE MEASURE PROPONENT (INCLUDE OISTRICi NUMNER IF APPUGRLE) YEAR OF EJECTION Pgptt Karen Goh Mayor 2016 9 NanWnisan r -.. -- If NonwraFRn Primarily formed to support or oppose specific Candidates or meawres in a single election. list below: CANOIDATEISI NAME OR MEASUREISI FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATED) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION IINCLUDE DISTRICT NO, CITY OR COUNTY AS APPLICABLE) FPPC Form 610 (Jan/2016) FPPC Advice: advice@fppc.ca.gov )866/275 -3772) www.fppc.ca.gov MF[R O SUPPORT n OPPOSE n POq} DD FPPC Form 610 (Jan/2016) FPPC Advice: advice@fppc.ca.gov )866/275 -3772) www.fppc.ca.gov