HomeMy WebLinkAbout2017.04.20_CAL_Form 41006)
Statement of Organization
Recipient Committee
Statement Type
7polL,
�Initlal 0 Amendment
Not yet qualified List I.D. number:
Date qualified as committee Date qualified as committee
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L Committee information
❑ Termination — See Part 5
List I.D. number:
Date of Termination
RE
in the office of the Secretary o
of the State of California
APR 03 2017
qls/17
For Official Use Only
RECEIVED AND :ILED
in the office of the Secretary of State
of the State of CA!iia
r. Treasurer and Other Principal Officers
THE URER
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STRrET ADDRESS (NO P.O.BDx) CITY STATE ZIP CODE AREA CODE/PHONE
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CRY STATE ZIP CODE AREACODE/PHONE NAME OFASSISTANT TREASURER, )IFANY
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COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
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Attach additional information on appropriately labeled continuation sheets.
3. Verification
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 Stet
6 2 Executed on — ( r 7 By
DATE
Executed an By
DATE
Executed on By
DATE
Executed on By
DATE
fE ZIP CODE AREA COD
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NAME OF PRINOPAL OFFICERIS)
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DATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. DR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (lan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
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