2018-11-05 Form 410 - MiddletonStatement of Organization
Recipient Commi ttee
Statement Typ e 0 Initia l V'3-Ame ndment
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0 Date qualification threshold met Date qualification threshold met
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~· Committee Information II.D. Number
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NAME OF COMMITTEE
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STATE ZI PI~rOE
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AREA CODE/PHONE
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~UNTY OF DOMICILE ,u '-f·;:xC_ s \ ,-:-:>~
JURISDICTIOMERE COMMITTEE IS ACTIVE
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Attach additional information on appropriately labeled continuation sheets.
DATE
Executed on By
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Da te Stamp J CALIFORNIA 410 RE< EIVED AND FILED FORM
D Te rmina t ion -See p!n-P!f' ~tn ce of th~ Secretary of State For Official Use Only bt the State of Califcm la
Date of termination NOV 05 2018
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I 2. Treasurer and Other Principal Officers ,
NAM E OF TREA SU ~
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STREET ADDRESS INO P.O. BOX)
CITY ZIPCOOE • C{z.2~<-\. AREA CODE/PHO NE
NAME OF ASSIST'liiT1REASURER,Ir\"NY -_.,.. ' u ~c..-"-.. ;\ \ 0 0 ---=--( 0 "-...)
CITY STATE ZIP CODE AR EA
NAM E OF P RIN CI~Al OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PtlOIIE
I ce rtify under
DATE SIGNATURE OF CO NT ROlli NG OFFICE HO LDER. CANDIDATE , OR STATE MEASURE PROPOriENT
Executed on By
DATE
Executed on By
DATE
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SIGNATURE Of CO NT ROLLING O fFICEHOlDER, CA NDIDATE , OR SlAT( MEASURf-PROPOUf NT
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FP PC For m 4 10 (A ugust /2018}
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