Statement of Organization Recipient Committee

Date ~tag1p rll t.u CALIFORNIA 41 0

~ FORM Statement Type ~Initial 0 Amendment

List I. D. number:

0 Termination- See Part 5 List 1.0. number:

fH1f I C f. 0 F T H .E C I T Y C L £ Of. KLANO For Official Use Only

Not yet qualified 0 or 14 HAY 30 PH 1: 30 #------- # ______ _

/ 5 , 2~14 1-1 ---1, ·--- --- --- --JI /--Date qualified as committee Date qualified as committee

(If oppllcoblt ) Date of Termination

'-· Committe" Information · ,__ · · • ·· t ~ ::a__· _ 2. fieuurirand Otharl•nncljiJ NAME OF COMMITTEE NAME OF TREASURER

ChArles g ());I h q ll') 5 for f)(~jor 0 r 0& kl qt")J Zalt./ 0 e I J 4 13'. 5An e h~ 2 STREET A0

CITY STATE

Or-lkl.qnJ CtJ ZIP CODE

qt.;b08 AREA CODE/ PHONE CITY

510 ·· AREA CODE/PHON E

s 10 - MAILING ADDRESS (IF DIFFERENT)

o X4/Jder FAX I E-MAIL ADDRESS

~ AoL com CITY STATE ZIP CODE

pi If s· b u rq e;; Cj(/'f'(, S' AR EA CODE/PHON E

qz>" -JURISDICTION WHERE COMMITTEE IS ACTIVE

f.qmecJq I Ai.t1rneci4 NAME OF PRINCIPAL OFFICER(S) OJ'

Jerof??e /1l. ./lew lo/J Attach additional information on appropriately labeled continuation sheets.

STREET ADDRESS (NO P.O. BOX)

CITY 0 /J ;, /t;ad c4 '/¥602 ZIP CODE AREA CODE/PHONE

5/0-

I have used all reasonable diligence ~~is--staten'fen~ tk: 7:~ my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of

Executed on

Executed on

Executed on

Executed on

s ... o!o-Zo~tt <::>" EASURER _/

~,~~,2P/YBy ______ -------(}eldfl ciiJ/i

:Je rol"? C 5-.3tJ-2()/ v By --~ ;;m;r----DATE

s .. ~~-201 'I By ... . Chl;rles FPPC Form 410 (Dec/2012)

FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov

Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE

CALIFORNIA 41 0 FORM

COMMITTEE NAME c); ,4 f /e 5 R. U/i/J; :.t;m5 for or of' ll /Jc/ Zo·t· I.D. NUMBER

• All committees must list the financial Institution where the campalan bank account Is located.

NAME OF FINANCIAL INSTITUTION AREA CODE/ PHONE BANK ACCOUNT NUMBER

hrsl /3fJIJ /f yoo- 7?:,0 - 2 '26 5' ADDRESS

I J 1.JO 5.411 fJII/;.;o CITY STATE

~ve; 5 /e /l S41? P;:;blo ZIP CODE

ell C?vro0 4. TYPe of Committee conjliti_ffii_ippUeable stctton&.

Controlled (cJ/Jlllllltcc

• List the name of each controlling officeholder, candidate, or state measure proponent. If candidate 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 identification number of the other controlled committee.

NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT

C); /lr /e S" R UJ, //, .tJmS

-- - ~ - ----

ELECTIVE OFFICE SOUGHT OR HELD (INClUDE DISTRICT NUMBER IF APPLICABLE)

/IJ/Ii.j Or CJ ( 0/J k ft1r1J -

---- ---- ----~

YEAR OF ELECTION PARTY

2cJ!t./ 0 Nonpartisan

0 Nonpartisan

Pnmanfy Formed (omrwttcc Primarily formed to support or oppose specific candidates or measures in a single election. List below:

CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION

(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE

------~~-su~r=o=Rf~~ De:]

I SEll OL]

FPPC Form 410 (Dec/2012) FPPC Advice: advice@lfppc.ca.aov (866/275-3772)

www.fppc.ca.gov

Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE

. 4/~ 1/,!;ms For (fl;;j o~'" or Oa l -l4acl 2 o I tf

CALIFORNIA 41 0 FORM ..

1.0. NUMBER

Gt•ncrol Purpo"' Comnuttcc Not formed to support or oppose specific candidates or measures in a single election. Check only one box: 0 CITY Committee 0 COUNTY Committee 0 STATE Committee

PROVIDE BRIEF DESCRIPTION OF ACTIVITY

Spon,orcd (ommrttct• list additional sponsors on an attachment.

NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR

STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE

)moll Cont11Lwtor Cormmttcc 0-1-1--

Date qualified

s: tarmtnatlon ly llplna tile verlflclllcln, tM treiUW, .ust.nt treuurer lf'td/or candidate, ofllteholdtlr, or proponent certify ttllt all of the followtna tonc11t1ons have been met:

• This committee has ceased to receive contributions and make expenditures;

• This committee does not anticipate receiving contributions or making expenditures in the future;

• This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;

• This committee has no surplus funds; and

• This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.

There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519.

Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511 - 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5.

FPPC Form 410 (Dec/2012) FPPC Advice: advice@fppc.ca.gov (866/275-3772)

-w.fppc.ca.gov