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NAME OF COMMITTEE
Steven Ly for Rosemead 2022
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Rosemead CA 91770
FULL MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
COUNTY OF DOMICILE JJURISDICTION WHERE COMMITTEE IS ACTIVE
Los Angeles City of Rosemead
Attach additional information on appropriately labeled continuation sheets.
NAME OF TREASURER
Steven Ly
STREET ADDRESS (NO P.O. BOX)
CITY
Rosemead
STATE
CA
ZIP CODE
91770
AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
STREETADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
I have used all reasonable diligence in preparing this statement and to the best of my knowledge
penalty of perjury under the laws of the State of California that the f egoing is true and correct.
Executed on Ob S 7A)g By
,{� _ DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on C/�jS�i�z-t1f
By
DATE
information contained herein is true and complete. I certify under
Executed on
DATE
-IUNAI Ulit OF W N I RULLINU ULLICLHULULR, LAN UIUAI E, OR STATE MEASURE PROPONENT
By
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(August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA
Recipient Committee F1191Z 411
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I.D. NUMBER
Steven Ly for Rosemead 2022 1314292
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Chase Manhattan Bank 1(626) 291-5816 1844962381
ADDRESS
CITY
STATE ZIP CODE
9647 E Las Tunas Dr Temple City CA 91780
4:. y + ofG�trn tli ee Corriplexe the ppitM e secti' hs
• 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." 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 PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION
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
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
SUPPORT
Nonpartisan
Partisan
(list political party below)
SUPPORT
OPPOSE
Nonpartisan
Partisan
(list political party below)
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
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
FPPC Form 410(August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410(August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee Type or print in ink Date Stamp I ,
Statement Type ❑ Initial
Notyetqualified ❑ or
I I
Date qualified as committee
1. Committee Information
NAME OF COMMITTEE
® Amendment
List I.D. number:
# 1314292
I I
Date qualified as committee
(If applicable)
❑ Termination —See Part 5
List I.D. number:
Date of Termination
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Steven Ly for Rosemead 2013 Kimberly Sabol
STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE
Rosemead CA 91770
CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IFANY
Rosemead CA 91770
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX E- MAILADDRESS
IF DIFFERENT
THAN COUNTY OF DOMICILE
Attach additional inPormation�on appropriately labeled continuation sheets.
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODEIPHONE
NAME OF PRINCIPAL OFFICERS)
STREETADDRESS(NO P.O. BOX)
CITY STATE ZIP CODE AREA CODEIPHONE
3. Verification
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 th I aws of the State of California that the foregoing is true arH ^ ^« = ^f
Executed on 2/21/2013 By
IAIE
Executed on 2121/2013 By
Executed on
DATE
Executed on
DATE
I certify under penalty of
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (April /2011)
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276 -3772)
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Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee Type orprintin ink Data Stamp
Statement Type ❑ Initial
Not yet qualified ❑ or
Date qualified as committee
1. Committee Information
Xf Amendment
List I.D. number.
a t3\ 4L'�lz
NAME OF COMMITTEE II
!S n1tA Ll t 1- ' iPSt M to d
n Termination — See Part 5
List I.D. number.
a
(Z. I, F 01 1 f—
Dale qualified ascommittee Date of Termination
(It eppfi a le)
CITY SrATE ZIP CODE AREA CODE/PHONE
II�rW
(IF DIFFERENT)
OPTIONAL: FAX / E -MAIL ADDRESS
2. Treasurer and Other Principal
NAME OF TREASURER
AUG 2 6 2009 .
STREET ADDRESS r
CITY STATE ZIP CODE AREA CODE/PHONE
gZew,.ee I Gfi %117o
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
COUNTY OF DOMICILE (COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE MAILING ADDRESS
Attach additional inthanation on appropriately labeled continuation sheets.
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my
perjury under the laws of the State of California that the foregoing is true and correct.
Executed on 2 D D / Ely
DATE
,�,
Executed on gj
DATE
CITY STATE ZIP CODE AREA CODE/PHONE
the information contained herein is true and complete. I certify under penalty of
Executed on B,'
DATE SIGNRURE OF CONTROLLING OFFICEHOLDER, CANDID/PE, OR STATE MEASURE PROPONENT
Executed on Ely
DATE SIGNATURE
FPPC Form 410 (Jan/01)
FPPC Toll -Free Helaline- 866 /ASK•FPPC
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
i FG.Terrw�l
4. Type of Committee Complete 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.
OR
NAME OF CANDID/PE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT AP HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
rule r( CF
6z6 &-z --)-io4
ADDRESS CITY - - CITY I /STTA,TAE oZI�P CODE
Primarily formed to support or oppose specific candidates or measures in a single election. Listbelow.
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)
OPPOSE
FPPC Form 410 (Jan101)
FPPC Toll -Free Helpline: 8661ASK -FPPC
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
4. Type of Committee (Continued)
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
NAME OF SPONSOR
List additional sponsors on an attachment.
❑ _ I I
Date qualified
u rr
GROUP OR AFFILIATION OF SPONSOR
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and /or candidate, officeholder, or proponent certify that all of the following conditions 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 (June /09)
FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275-3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page J
4. Type of Committee (Continued)
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
VCITYCommittee COUNTY Committee nSTATECommittee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
5ny,rA AMw ls5ues ti ,ka ca4Ac 4 amn
List additional sponsors on an attachment.
NAME OF SPONSOR
GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE
F1 II Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a small
Date qualified contributor committee on January 1, 2001, enter 1/1/01.
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and /or Candidate, officeholder, or proponent certify that all ofthe following conditions 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
Govemment Code Section 89519.
Additional filing obligations will be incurred if, after terminating, the committee receives or spends any funds, or receives the forgiveness of a loan,
repayments of loans made to others, or any other receipts.
FPPC Form 410 (Jan /01)
FPPC Toll -Free Helpline: 866 /ASK -FPPC
\0\
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my know[ dge the information contained herein is true and complete. I certify under penalty of
perjury under the laws of the State of California that the foregoing is true and correct.
Executed on /2t/07 BY
8
DATE
..��...,.e..,,.,�..«,.�.,.., ,.�.. �..,......�..e�...�..�.�, ..�.,.,...,...�.,.
Executed on Ely GATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDRE, OR STATE MEASURE PROPONENT
Executed on BY
DATE SIGNXURE OF CONTROLLING OFFICEHOLDER, CANDIDKE, OR STATE
FPPC Form 410 (Jan /01)
FPPC Toll -Fran Helnlina: 666 /ASK -FPPC
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
2
o Se✓ J
4. Type of Committee Complete 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.
NAME OF
ELECTIVE OFFICE SOUGHT OR HELD
MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION AREA CODEIPHONE BANK ACCOUNT NUMBER
&4 k 4 Annericti (g26f 3) 2 -2I V4
ADDRESS CITY STATE ZIP CODE
zctyw"� CA 11770
Primarily formed to support oroppose specific candidates or measures in a single election. Listbelow:
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
FPPC Form 410 (Jan/01)
FPPC Toll -Free Helpline: 866/ASK-FPPC
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
4. Type of Committee (Continued)
7
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
VCITY Committee [DCOUNTYCommittee nSTATECommittee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Suq�Qr�, 1Me �Ssues ti�a ta�J;�ak of Skeen
List additional sponsors on an attachment.
NAME OF SPONSOR
GROUP OR AFFILIATION OF SPONSOR
J Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a small
Date qualified contributor committee on January 1, 2001, enter 1/1/01.
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and /or Candidate, officeholder, or proponent certify that all ofthe following conditions 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.
-- Additional filing obligations will be incurred if, after terminating, the committee receives or spends any funds, or receives the forgiveness of a loan,
repayments of loans made to others, or any other receipts.
FPPC Form 410 (Jan/01)
FPPC Toll -Free Helpline: 8661ASK -FPPC
Statement of Organization T ype or print In Ink STATEMENT OFORGANIZATION
Recipient Committee
Statement Type ❑ Initial
Nolyelqualified ❑ or
f
Date qualified as Committee
1. Committee Information
NAME OF COMMITTEE
STEVEN LY FOR ROSEMEAD
STREETADDRESS (NO P.O. BOX)
® Amendment
List I.D. number:
#1314929
12 t 0 8 t 08
Dale qualified as committee
(II appllceble)
❑ Termination —See Pa 5
List I.D. number: It I FEB 0 3 201
Date of Termination I I BY
.
CITY STATE ZIP CODE AREA CODE/PHONE
ROSEMEAD CA 91770
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX /E -MAIL ADDRESS
OF DOMICILE COUNTY WHERE COMMITTEE
THAN COUNTY OF DOMICILE
111
2. Treasurer and Other Principal Officers
NAME OF TREASURER
PHILLIP T. THONG
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODF/PHONE
ROSEMEAD CA 91770
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREACODE/PHONE
NAME OF PRINCIPAL OFFICERS)
STEVEN LY
STREETADDRESS(NO P.O. BOX)
CITY STATE ZIP CODE AREACODE/PHONE
Attach additional information on appropriately labeled continuation sheets. ROSEMEAD, ' CA 91770 .
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information cont aiged herein and complete. I certify enalry of
perjury under the laws of the State of California that the foregoing is true and correct. / \
Executed on JAN 19, 2 010 By
DATE
Executed on JAN 19, 2010 By
DATE
Executed on BY
Executed on BY
GATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
FPPC Form 410 (June /09)
FPPC Toll -Free Helpline: 8661ASK -FPPC (8661275 -3772)
STATEMENT
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
LY
4. Ty pe of Committee Complete the applicable sections.
29
• 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 YEAR OF ELECTION PARTY
NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE)
® Non - Partisan
STEVEN LY CITY COUNCIL
'T I I LJ Non Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
r.�ss CV!Y
STATE ZIP CODE
ADDRESS
8905 LAS TUNAS DR. , TEMPLE-CITY CA
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)
ONE
FPPC Form 410 (June /09)
FPPC Toll -Free Helpllne: 866 /ASK -FPPC (866/276.3772)
- S:atelnent of Organization
Recip ent.Committee "
Statement Type Initial
Not yet qualified ❑ or
I I
Date qualified as committee
1. Committee Information
NAME OF COMMITTEE
Sieves L, for 'jZgSe�tca�
STREETADDRESS(NO P.O. BOX)
CITY
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX /E -MAIL ADDRESS
COUNTY OF DOMICILE
Type or print In Ink
EcEt,vED By
� CCCCCJ� s_=, 6 V J a -c1 4ya r r
❑
Amendment—GS 17- Perm iriation — See Pa 6 Cy -��- ^'
List I.D. number: Lis Q. rqn-%: .
# 2009 JAH 12# � I 40 DEC 08 1008
CA'riPAIGM F{W.AP+� ,..- ....:.___
I OSUt min
Date qualified as comfi�i tie— - Dale of Termination � 1,
pl eppllraNe)
STATE ZIP CODE AREA CODE/PHONE
THAN COUNTY OF DOMICILE
Attach additional information on appropriately labeled continuation sheets.
IF DIFFERENT
2. Treasurer and Other Principal Officers
STATEMENT OF ORGANIZATION
DEC 2'2 2008
BOWEIN
NAME OF TREASURER
Dia,A }errerc,
STREET ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
4CtyC lead CA I1-no
IF ANY
STREET ADDRESS
STATE ZIP CODE AREA CODEIPHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE /PHONE
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 penalty of
perjury under the laws of the State of California that the foregoing is true and correct.
Executed on
DATE
Executed on I ?d a `0 g
DATE
Executed on
Executed on
DATE
By
By
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Januaryl05)
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275 -3772)
.a►i► ate-.;
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
teae,) L1 4r
4. Type of Committee Complete 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 CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF ELECTION PARTY
S�cven L
i��sewlea� C; Cs>..�,G11�.1e•v+6Br
2 ° °5
Non - Partisan
Non - Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION
ADDRESS
AREA CODE /PHONE
CITY
STATE ZIP CODE
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)
CHECKONE
)RT OPPOSE
FPPC Form 410 (January/05)
FPPC Toll -Free Helpline: 666 /ASK -FPPC (6661276 -3772)
Statement of Organization
Recipient Committee
Statement Type EJ Initial
Not yet qualified ❑ or
I I
Date qualified as committee
1. Committee Information
NAME OF COMMITTEE
3 4earen L, 4c 'RgSewlca�
STREET ADDRESS (NO P.O. BOX)
CITY
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX I E -MAIL ADDRESS
COUNTY OF DOMICILE
THAN
Type or print In Ink
❑ Amendment
List I.D. number:
is
Dale qualified as committee
(If applicable)
❑ Termination —See Pa 5
List I.D. number: j
a
Date of Termination j
STATE ZIPCODE AREA CODEIPHONE
IS ACTIVE IF DIFFERENT
Attach additional information on appropriately labeled continuation sheets.
STATEMENT OF ORGANIZATION
DEC 0 8 2003
B.
2. Treasurer and Other Principal Officers
la
STREET ADDRESS
CITY STATE ZIP CODE AREA CODEJPHONE
Pwsc.�oerl C'A `I-no
STREET ADDRESS
CITY STATE ZIP CODE AREA CODFJPHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS
STATE ZIP CODE AREA CODE /PHONE
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 penalty of
perjury under the laws of the State of California that the foregoing is true and correct.
Executed on
DATE
Executed on `5 g
DATE
Executed on
Executed on
DATE
By
By
By
SIGNATURE OF CONTROLDNG OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLUNG OFFICEHOLDER. CANDIDATE. OR STATE MEASURE PROPONENT
FPPC Form 410 (January/05)
FPPC Toll -Free Helpline: 866IASK -FPPC (8661275.3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
NAME
e 1) L, -o r
4.Type of Committee Complete the applicable sections.
Page 2
• 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 CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
SAmt'rt
�i ��
P' —S"e4 Ci �AU�1G� mem�r
200
0 Non- Partisan
❑ Non - Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL
ADDRESS
AREA CODEIPHONE
CITY
nnnn AUUUUN i NUmecn
STATE ZIP CODE
Primarily formed to support or oppose specific candidates or measures In a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
FPPC Form 410 (January/05)
FPPC Toll -Free Helpline: 866 1ASK -FPPC (866/275.3772)