HomeMy WebLinkAboutABRAHAM 410 AMENDStatement of Organization
Recipient Committee
Statement Type [] Initial
Not yetqualified [] or
Type or print in Ink
~'~'mendment
List I.D. number:
#1 vqq
I I I I
Date qualified as committee Date qualified as committee
1. Committee Information
STREET ADDRESS (NO RD. BOX) ,
I~AILIN~ ADDRESS (IF DIFFERENT)
[] Termination - See Part 5
List I.D. number:
L~
Date of TenminalJon
Date Stamp
~_~,,T-~ ?f: ..0fl
STATEMENT OF ORGANIZATION
Fo~ Official Use Only
OPTIONAL: FAX / E-MAIL ADDRESS
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Attach additional informaEon on appropriately labeled continuation sheets.
2. Treasurer and Other Principal Officers
E OF TREASURER , _
ST.EET ADDRESS
STREET ADDRESS
CITY 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
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my/4~nowl,ed[le the infoFnal~on contained herein iAtrue and complpte. I certify under penalty of
perjury under the laws of the State of Califomia that the foregoing is true and correcV. [' ,~ / // /~' . I'
~ ~'J [ ~-- ~/ / ,~IGN~TURE~rT~'REASURER~{~ ASSISTANT T~EAS U RER
~e~ed on ~
~ SI~URE OF CONTR~L NT
Ex~t~ on ~
~ SIGNORE ~ C~ROLLING ~FICEH~ER. ~DIDATE, OR STA~ M~U~ ~OP~E~
FPPC Form 410 (Jan/01)
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