HomeMy WebLinkAboutMCDERMOTT 410 TERMINATION 9/00Statement of Organization
Recipient Committee
Type or print tn Ink
Statement Type
[] Initial
Not yet quatilted [] or
[] Amendment
Us~ I,D. number.
#m
I I I I
Date quaifted as corr~nittee Date qualified as committee
(1~ ~, ~,ba)
1. Committee Information
NAME OF COMMrTTEE
STREET ADDRESS {NO P,O, BOX)
OPTIONAL: FAX I E.MAIL ADDRESS
L~ i. ;.rm~l~lr.°n- see Part $
Dale of Termination
2. Treasurer and Other Principal Officers
STATEMENT OF ORGANIZATION
COUNTY OF IX)MICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
Attach add/Uona/informat/on on appropn'ale/y/abeledco~#nuat/on sheets.
NAI~'OF AS~STA~I' TREASURER, IF ANY
MAlUNG ADDRESS
CITt' STATE ZIP CODE AREA CODE/PHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS
CITY
STATE ZIP CODE AREA CODE/PHONE
Verification
have used all reasonable diligence in preparing this statement and to the best of my knewle_dge the information contained herein is tree and complete. I certify under penalty of
perjury under the laws of the State Of California that the foregoing is true and co[p~'~:~ /r~- /~ /') ,/~ --
Executed on DATE
FPPC Form 410 (8/99)
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