HomeMy WebLinkAboutCLOUD 410 AMEND 09/16/16Statement of Organization
Recipient Committee
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Date qualified ascommittee Dale of Termination
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Attach additional information on appropriately labeled continuation sheets.
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NAME Or TREASURER
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NAME Or rRINCIrAL OmCIEW
1 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 o�f�Cajlif�om/ia% that the fore ng is true and correct.
Executed On r /6 By /%x
On r E SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed an By
Executed On �`/ By
Executed On By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. ON STATE MEASURE PROPONENT
FPPC Farm 930 (Jan 13036)
FPPC Advice: advice @fppc.ca.gov (8661275 -3772)
www.fppc.ca.gov,
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
All committees most list the financial insdtudon where the campaign bank account is located.
NUMBER
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.
List the political party with which each officeholder or candidate is affiliated or check "nonpartisan."
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CAROL RATE/ OFFICEHOLDER /STATE MEASURE PBOPON ENT (IN CLU GE DISTRICT NUMBER I F APPLICABLE) YEAR OF ELECTION PARTY
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Nonpartisan
❑ Nonpanian
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(5) NAME OR MEASUREIS)FULL TITLE (INCLUDE BALLOT ND. OR LETTER) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE( 1.11R UP,
FPPC Form 410 (Jan /2016)
FPPC Advice: advice@fppc.ca.gov (866/215 -3712)
www.f"GCAgov