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Statement of Organization CALIFORNIA 41 0Recipient Committee ott t. Uf THE CIT '1 {;Lt;.H '" FORM
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FPPC Form 410
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www-fppd:a.gov
Statement of Organization 	 ;- j le. ttl CALIFORNIA 410Recipient Committee 	 dr t il;t. UF THE CIT '( CU:Ji" FORM
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NAME OF FINANCIAL INSTITUTION
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4. Type of Committee Complete the applicable sections.
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• 	 List the name of each controlling officeholder, candidate, or state measure proponent. If c~nrlidate 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 identificCltion number of the other controlled committee,
ELECTIVE OFFICE SOUGHT OR HELD
NAME Of CANDIDATE/OffiCEHOLDER/STATE MEASURE PROPONENT
Jo
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
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YEAR Of ELECTION PARTY
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Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election, List below:
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CANDIDATE(S) NAME OR MEASURE(S) fULL TITLE (INCLUDE BALLOT NO. OR LETTER)
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FPPC Advice: advice@fppc.ca,gov (866/275-3772) 

www.fppc.ca.gov

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Controlling Candidate Measure Proponent

  • 1. ......,, . . (ONfROILINGOHIUihllj'1! (ANDIIlAll M(;SUHf pROPONENT ~I Statement of Organization CALIFORNIA 41 0Recipient Committee ott t. Uf THE CIT '1 {;Lt;.H '" FORM OAKlflNDStatement Type For OfficIal Use Only~endmentInitial Termination - See Part 5 List I D. number: Li<;t I,D, nllmber Not yet qualified 0 or 1 JUL 2" PM I: I I # 1~)qv'1: 11 ________ _ 1_I_lJ2l/~)p -::, --1--1-­Date qualified as committee Date qualified a:. committee Date of Termlnntlon pf .lppl'('lbjr} 1. Committee Information 2. Treasurer and Other Principal Officers "'MIN;'CrrvE~fAI Pt,{ MA' l<:~:rr Lq w ';:lR ottJ p~VE (I1Y ~TATt ZlPtOPI ARrA((lUC/f'rlilN! rOOF jPHONf Gis~LAvV() G-A 1l.f6/V '5J i [) ~k..L /+fJ() t-A 1'ijb (( ~~JO MAIliNG AODREIS IIC DIFFFRENT) NAf1f t.',<,hIAII1 ANY FAX I E-MAIL ADDRES~ :,rhf I I 'rlfJI{I iNO ro BOX) (I r 'I SlAl[ lIr AREA (OOf/PHONE tJO NifH r'RINlIi'Al Attach additional on appropriately labeled continuation sheets. AREA 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 P''''tvof pee;u" Executed on / ~L c:ltll:> By I pH UPd')the ',w; of th' Stot, of ~ ,''.~,," '711e;/2.t7J 3Executed on nAH Executed on Executed on By GAl t ----------------------~S~j(~;N~A~,7u~R~F~O~F~(~o7N~r7R=o7,l7iN~(~;~O~f~rI7(~fI71(~!l~n~I~"-,(~A~N~n~,~n7Al~f~07f~(7TA~I~r~~7H~A~'~u7,1{7r~p~Ro~P~O~N7,E~N~T---------------------- FPPC Form 410 FPPC Advice: advice@fppc.ca.gov (866/275-3772) www-fppd:a.gov
  • 2. Statement of Organization ;- j le. ttl CALIFORNIA 410Recipient Committee dr t il;t. UF THE CIT '( CU:Ji" FORM O..... KLANDINSTRUCTIONS ON REVERSE In NUMBrp :11 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION VJe.~ ~~ ear1l AREA cO[nlf'Il0Nf 5/0'-530 -(6~6"3 flANK ACCOUNT NUMBER ADDRESI rlfY 'dfIJF liP CODEJ 2J.dO .(Y")JV'+C( i.v etvc( OAkLA~o a CfLj b t 4. Type of Committee Complete the applicable sections. ControneiTComiiiitfee-­ • List the name of each controlling officeholder, candidate, or state measure proponent. If c~nrlidate 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 identificCltion number of the other controlled committee, ELECTIVE OFFICE SOUGHT OR HELD NAME Of CANDIDATE/OffiCEHOLDER/STATE MEASURE PROPONENT Jo (INCLUDE DISTRICT NUMBER IF APPLICABLE) OA~LAtVD YEAR Of ELECTION PARTY o Nonpartisan Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election, List below: CflNI1IDflTl(S) OFfiCI SOUGHT OR HELD OR MEASURE(S) JURISDICTION CANDIDATE(S) NAME OR MEASURE(S) fULL TITLE (INCLUDE BALLOT NO. OR LETTER) (INCLIIDE DISTRICT NO, CITY OR COUNTY, AS APPLICABl.E) CHECK ONE I SUP D 1 0 0 ISUOT IOu FPPC Form 410 (Dec/2012) FPPC Advice: advice@fppc.ca,gov (866/275-3772) www.fppc.ca.gov