HomeMy WebLinkAboutHANSON 410 00 tatement of Organization
Recipient Committee
Statement Type /~nitial
Not yet qualified [] or
Type or print in Ink
[] Amendment
List I.D. number:
I I
Date qualified as committee Data qualified as committee
(ff applicablg)
1. Committee Information
NAME OF COMMITTEE
STREET ADDRESS (NO P.O. BOX)
STATE ZIP CODE
MAILING ADDRESS (IF DIFF"~:R ENT)
[] Termination - See Part 5
List I.D. number:
#
L;AK
Date of Termination
Date Slamp
STATEMENT OF ORGANIZATION
For official Use Only
2. Treasurer and Other Principal Officers
AREA CODE/PHONE
NAME OF TRBASU ER
MAILING ADDRESS~ ~,
¢¢~Y - ~) ~) STATE
NAME OF ASSI~ANT TREASURER. IF ANY
ZIP CODE AREA CODE/PHONE
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODEJPHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S). IF APPLICABLE
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
~ COUNTY WHERE COMMITfEE IGCAOTI~/E F O FFERENT
COUNTY OF DOMICILE
~? ~ THAN COUNTY OF DOMI6
I
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
perjury under the laws of the State of California that the foregoing is true and correct,
Executed on
Executedon
Execuledon
DATE
DATE
I SGNATUREOPCONT~OLLiNG~i~iCEHOLDER, CANDiDATE, ORSTATEMEASUREPROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 4!0 (8/99)
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMI I I I:: I::~_l ~E *
Page2
ID. NUMBER
4. Type of Committee complete the applicable sections.
· 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
distdct number, if any, and the year of the election.
· List the political pady with which each officeholder or candidate is affiliated or check "non-padisan."
· If this committee acts jointly with another conlrolled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PAR'P/
, ,,-~Non*Partisao
'> I [] Non-Padisan
· List the financial institution and the disposition of surplus funds (controlled "candidate election" committees only)
NAM E.~F~ FINANCIAL INSTITUTION AREA CODE/PHONE
ADDRESS CI~' STATE ZIP CODE
BANK ACCOUNT NUMBER
DISPOSITION OF SURPLUS FUNDS
l;~dl.,~,':l~l~r~,z*,'~t:z,l~e;*'.*~*~lJI[:~.~ Primarily formed to support or oppose specific candidates or measures in a single election. List 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 COUNT
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (8/99)
For Technical Assistance: 916/322-5660
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMII 1 ~:E NAME
STATEMENT OF ORGANIT, ATION
Page3
I.U. NUMBER
4. Type of Committee (Continued}
~'4m,"4~.ll;~l~.Zo~.-f--~'ol~l~i,l~ Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
[] CITY Committee [] COUNTY Committee [] STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List addilional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
MAILING ADDRESS NO. AND STREET CiTY STATE ZIP CODE
~ [] (For purposes of special election contribution limits)
· This committee has ceased to receive contributions and make expenditures;
· This committee does not anticipate receiving contributions or making expenditures in the futura;
- This committee has eliminated or has no intention or ability to discharge all debts, loans raceived, and other obligations;
· This committee has no surplus funds; and
· This committee has filed all campaign statements raquired by the Political Reform Act disclosing all rapodable transactions.
-- There ara rastrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to
the Information Manual on Campaian Disclosure Provisions of the Political Reform Act, for Elected Officers, Candidates and their Controlled Committee:;
(Manual A).
- Additional filing obligations will be incurred if, after terminating, the committee receives or spends any funds, or receives the forgiveness of a loan,
repayments of loans made to others, or any other raceipts.
FPPC Form 410 (8199)
For Technical Assistance: 916/3~2-5660