HomeMy WebLinkAbout2016.08.25_Winholtz_Betty_Form 410Statement of Organization
Recipient Committee
Statement Type J4 Initial ❑ Amendment ❑ Termination —See Part 5
Not yet qualified El or
List I.D: number: List I.D. number:
Date qualified as committee Date qualified as committee Date of Termination
(If applicable)
Date Stamp
RECEIVED - LIvA
City of Morro Bay For Official Use Only
AUG 2 5 2016
Administration
1 Committee Informatlo,n _" 2. Treasurer and Other Principal, Officers
NAM E OF COMMITTEE NAM TREASURER
..%ill.' �a� z- f— r R MAYoo( 01to �EuE2i-(=y -:I—.
STREET ADDRESS (NO D. BOX)
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE
CITY STATE ZIP CODE - AREA CODE /PHONE
M o r lr o J3 C-t. �i C` 6 f'13 `i` 2 (
MAILING ADDRESS (IF DIFFERENT
FAX / E -MAIL ADDRESS
NAME OF ASSISTANT TREASURER, IF ANY -
N /' - ,,
STREET ADDRESS (NO,,P`O. BOX)
STATE ZIP CODE AREA CODE /PHONE
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
Obis a C ,+ 'of MoRleo &y � Ofi� k f-t,
STREET ADDRES (NO P.O. BOX)
,
CITY STATE ZIP CODE AREA CODE /PHONE
Attach additional information on appropriately labeled continuation sheets.
CSI 3 ttz
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£Cifornia that foreeggroing is true and correct.
Executed on /�') 'l /CIO % l� By << &
c� r DATE SIGN URE OF TREASURER OR ASSISTANT TREASURER
/
Executed on 12—VII is By � % CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE
Executed on
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENI
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Jan/2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov