HomeMy WebLinkAboutForm 410 - Mahmoud A. Shirazi; State 3R
ECEIVE,D AND FILE-1)
i the office D#the Secretary of State
rj of the State of California
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tatient oinnnajtlo� �jp
UL 28 2025
Recipient Co�"'ttee
Statement Type ®i itia Q Amendment gTermination -- See
cDpt e6'S ®FFI
U Date qualification threshold met Date qualification threshold.met Date of termination
I.D. Number /t/-'7q /7fnppllCable) m_
NAME OF COMMITTEE A
SFREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
FULL MAILING ADDRESS (IF DIFFERENT)
E- / FAX (OPTIONAL)
WHERE COMMITTEE ISACTIVE
Attar-h additional information on appropriately labeled continuation sheets.
NAME OF TREASURER
F E B - 5 2025
ITY CLERK'S CFFIC
STREET ADDRESS (NO P.O. BOX) CITY
EMAIL ADDRESS OFTREASURE (REQUIRED)
NAME Of ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX) CITY
EMAILADDRESS OF ASSISTANT TREASURER (REQUIRED)
NAME OF PRINCIPAL OFFICE
STREET ADDRESS (NO P.O. BOX) CITY
EMAIL ADDRESS OF PRINCIPALOFFICER(S) (REQUIRED)
For Official Use Only
STATE
/r
ZIP CODE
AREA CODE/PHONE
STATE ZIPCODE
AREA CODE/PHONE
STATE ZIP CODE
AREACODL"/PHONE _
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
penalty of perjuryunder the laws of the State of California that the foregoing is trueyand correct.
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Executed on ,/`
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'-
OR STATE MEASURE PROPONENT
Executed on �- _ R
GATE y SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 {Uetotser/2023}
FPPC Advice: ad'a:€= ?u.(666J275-37e2)
Staiament of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Page 2
I.D. fMj3F
All committees must list the financial institution where the campaign bank account is located and the person(s) authorized to obtain bank records.
NAME OF FINANCIAL INSTITUTION AND ER5ON{S) AUTHORIZED TO OBTAIN BANK RECORDS
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ADDRESS OF FINANCIAL INSTITUTION
AREA CODE/PHONE
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CITY
akbboi&
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,
BANK ACCOUNT NUMBER
STATE ZIP CODE
List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." Stating "No party preference" is acceptable.
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 YEAR OF
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT PARTY
(IN i IhF nICTRt('T NIINiRFR IC ADD If`A RI Cl cl cl+rin.i
Nonpartisan
Partisan
(list political party below)
iI
f
Nonpartisan
Partisan
(list political party below)
Primarily formed to support or oppose specific candidates or measures in a single election. List below -
CAN DIDATE(S) NAME OR MEASURES) FULL TITLE (INCLUDE BALLOT No, OR LETTER) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
IFARECALL, STATE "RECALL"iN FRONT OFTHFnFFICFHninFa,cNAnac 11.1,.1 ._.__.._
.__..._. _... LI1 LU ONE
SUPPORT OPPOSE
SUPPORT OPPDSF.
FPPCC Form 410 (October/2023)
FPPCAdvice:;vtsos;,figg�roc.a:,s"z3..{i3fi5J27!a-373X)