HomeMy WebLinkAboutForm 410 - Whitney Hoyt for City Council 2011 TerminationStatement of Organization
Recipient Committee
Statement Type [1 Initial
Not yet qualified 0 or
I I
Date qualified as committee
1. Committee Information
3
Type or print in ink
El Amendment
List I.D, number.
Date qualified as committee
(if applicable)
WTermination — See Part 5
List LID. number.
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Date of Termination
NAME OF COMMITTEE R Ac,
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STREETAIDDRESS (NO P.O, Box)
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CITY� STATE ZIP CODE AREACODEIPHONE
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX/ E-MAIL ADDRESS
COUNTY OF DOMICILE
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COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Attach additional information on appropriately labeled continuation sheets.
Stamp
2. Treasurer and Other Principal Officers
STATEMENT OF ORGANIZATION
Use Only
[A/ t M -tG1 M0 'I J
ISTREET
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITYE ZIP CODE AREA CODEIPHONE
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STREET�DDRESS (NO P.O��X) 0
'CITY STATE ZIP CODE AREA CODEIPHCTNIE
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
perjury under the laws of the State of California that the foregoing is true ar
Executed on LA I I, By
DAI, F
Executed on 011, By
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Executed on
DATE
I certify under penalty of
By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING C)FFIGEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (April/201i)
FPPC Toll -Free Helpline. 866/ASK-FPPC (866/275-3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
STATEMENT OF ORGANIZATION
COMM�EE NAME y
C Z-01 I.D. NUMBER
0
4. Type of Committee Lplete the applicable sections.
& 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 "non-partisan."
* If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CAN DI DATE/OFF] CE HOLDERISTATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
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Non -Partisan
❑ Non-partisan
- List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANKAUUUUN1NUMbtK
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ADDRESS CITY STATE ZIP CODE
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Primarily formed to support or oppose specific Candidates or measures in a single election. List below
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
FPPC Form 410 (Apri1/2011)
FPPG Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)