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2022-05-17 - Form 410 - JacksonStatement of Organization Mesuww Recipient Committeeago Statement Type Initial ❑ Amendment ❑ Termination — See Part 5 For Official Use Only Not yet qualified 0(-b or µ_ ¢ j� � - .:f' E rty 1 O Date qualification threshold met Date qualification threshold met Jr Date of tenyination 1. • I.D. N .o Z.,, Treasurer and Other Principal Officers NAME OF COMMITTEE Nvt NAME OF TREASURER e. Vi io) 10 'o e,)cr L) ' �l >1 c- 4- �'`� STREET ADDRESS (NO P.O, 80Xj STREET ADDRESS (NO P.O. BOX) 1 / !J 0Z., 14,4 rh r1 l:� 1 jr�il �%' CITY ( C STATE � ZIP CODE AREA CODE/PHONE �1�i,11'� J �•i o '`i CITY STATE ZIP CODE AREA CODE/PHONE SP r(rn- C 4) 2,2 V q,45, __,Z 10 - C>"3 49L NAME OF ASS15TA7dTEAMIRMIF MY afr Ar ev- FULL MAILING ADDRESS 0 IFFERENT) I Art'r-eA -5 C*6'3 STREET ADDRESNO P.O, BOX) 311 Z E 10a V*-A rc fe'__ E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) Vo �e_,,Toe, + PS' ilrrw-i CITY STATE ZIP CODE AREA CODE/PHONE fen I Vr,_'rw, C A- 6 4- 4_1 COUNTY OF DOMICILE (vi�� iA e, JURISDICTION WHERE COMMITTEE IS ACTIVE pekAm'__SPV—'f-%S NAME OF PRIM PAL OFFI S) r,,,,,, STREET ADDRES01140 P.O. BOX) A Attach additional information on appropriately labeled continuation sheets. 3. Verification o CITY STATE ZIP CODE AREA CODE/PHONE � �� , �1�� `�� ,� � L,� � � y Z I have use all reasons e i igence in preparing this statement an to t e est v myknowledge--The information containe erein is true and complete. !certify under penalty of perjury under the laws of the State of California that the foreggrily is true and correct 14AAA Executed on �� i J By DATE SIGN E OF TREASU R OR ASSI ANT TREASURER i• Executed onBY t•' �� DATE SIGNATUIt F CONTROLLING OFFICE DER, CANUii?ATf, OR 5iA7f MEASURE PkUNUNENi Executed on By DATE 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: advice9OVK.ca.90v (866/275-3772) WWW.fppC,Ca.0_ov Statement of' Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME rr 44 rr, C I.D. NUMBER (2 • All committees must list the financial institution where the campaign bank account is located. NAME OF. FINANCIAL INSTITUTION AREACODE/PHONE BANK ACCOUNT NUMBER 1757 .E ADDRESS p� V/ • 4. Type of •mmittee Complete the applicable CITY STATE ZIPCODE pia�/ s•+ �•I `�,V • 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 CAN DIDATE/OFF ICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE _ fa� Al`S �' i 5 c: 1 ? `V10, Nonpartisan Partisan .(list political party below) Nonpartisan Partisan Qist political party below) Formed 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) CfiECK ONE SUPPORT OPPOSE SUPPORT OPPOSE FPPC Form 410 (August/2018) FPPC Advice: advice [K.ca&ov (866/275-3772) WWW fnr,c.ca.gov Statement of Organization Recipient Committee • • INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D. NUMBER VVI, 4�3 vo-ol r p. of Committee • General- Committee Rolformed to support or oppose specific candidates or measures in a single election. Check only one box: CITY Committee ❑ COUNTY Committee ❑ STATE Committee U 1 "i� ©� (%� GL" I 't � � 1 � '� t ��-,' � V � r/ U u.. �.��''� v / ti I - -� V" � � � � � f / � � L � s l �� -� 1 Sponsored List additional sponsors on an attachment. NAME OF SPONSOR MULIbiKT bKUUr UK ^rHuwiNw ut bMIEM c STREET ADDRESS NO, AND STREET CITY STATE ZIP CODE AREA CODE/PHONE Small Con tribtjtor Committee 13 Date qualified S. Termination RequirementS By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or ponent certify that all of the following conditions have been rnet • 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 byelected 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 (August/2018) FPPC Advice: adv1ce0fpDc.ca,g2v (866/275-3772) . www.fgDc.ca.gQv_