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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. 1 )1 L( o1 4 1 ok f. '50 1 I -oil Date of Termination NAME OF COMMITTEE R Ac, 1�- if , t & k S 0 � W �A Vk`lI\ 44.0\ A10 I - � `_3 - -l.7 STREETAIDDRESS (NO P.O, Box) � CITY� STATE ZIP CODE AREACODEIPHONE MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX/ E-MAIL ADDRESS COUNTY OF DOMICILE ( kv, 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 w k.. T. 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 _kTE 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 kv\ t V\ ���� 0 ( 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 VJ t k� I;r 0 0 ll,cab �S L koo ADDRESS CITY STATE ZIP CODE kkc, 0 1 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)