HomeMy WebLinkAboutBRAKEBILL SO tatement of Organization
R.~clpk-.nt Committee
[] Check box if an Amendment
and enter I.D. number:
INSTRUCTIONS ON REVERSE
1. Committee Information
[] Not yet qualified
File original end one copy with: DateSamp
Secretary of State
Political Refom~ Division
P~O. Box 1467
Sacramento. CA 95812-1467
County end City Committeac file · copy with:
Local filing officer who will receive the original
r~
clieclo~ure statemania,
Type or print in Ink
NAME OE COMMITTEE
ADORESSO~cCOMMITTEE NO AND STREET (NO F~O. BOX)
CJTY STATE ZIPCODE AREACtOR
~Ai~t.o AOORE SS tiF D,~ER~ .T~ .O ~. D STREET OR PC ~
2. Treasurer and Other Principal Officers
STATEMENT OF ORGANIZATION
410
1998 FORM
For Official Use Only
NAME OF TREASURER
MAILING ADDRESS
NAME ANO POSITION OF OTHER PRINCIPAL OFFICER(S).IF APPLICABLE
MAILING ADDRESS
cn'Y STATE ZIP CODE
CJTY STATE ZIP CODE AREA COOF-JPHONE NUMBER
O!~110NA~ AREA CODE/FAX NUMBER OI~FIK3NAL: E-MAIL ADDRESS
Attach additional information on appropdalely 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 c,~e~ct.~ /~ ~ ~/~
By
Executed on By
O^Te S~C, NATU~ 0~: CONT~:X.UN~ (~=~CEHO~Er~, C,~NO~OATE, OR STATE uru~su~E ~3oe,o~e~
For Technical A¢$lctenc¢: g16J322-$660
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
NAME OF CONIMITlrEE
4. Type of Committee: Complete the applicable sections.
STATEMENT OF ORGANIZATION
OA',FO."'A 410
1998 FORM
· List the polihcal party with which each officeholder or candidate is affiliated. An officeholder or candidate not holding or seeking a partisan office must indicate 'non-partisan,'
C. zT / 7
CANDIDATE'S NAME OR MEASURES FULL TITLE (INCLUDE BALLOT NO OR LETTER)
elSPOSITION OF SURPLUS FUNDS
l..~hl~:lilj~,~r.~e]IrllZ,:~.dB'4~reltZllt~rJi(~:~ Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDtDATE*S OFFICE SOUGHT OR HELD OR MEASURE'S JURISDICTION
(INCLUDE DISTRICT NO, CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
SUePOI~
Not formed to support or oppose specilic candidates or measures in a single election. Check only one box: [] CITY Committee
PROVIDE RRIEF DESCRIPTION OF ACTIVITY
[] COUNTY Committee
[] STATE Committee
MAILING ADDRESS NO AND STREET
CITY
IINDUSTRY GROUP OR AFFILIATION OF SPONSOR:
ZIP CODE
FPPC Form 410 (2/98)
For Technical Aaalatence: 916/322-5660