CA Form 410 Committee To Support Ken Dyda for Council 2015 - Aug 20, 2015 •
Statement of Organization Dat-,Stamp
CALIFORNIA 41 0
Recipient Committee
FORM
Statement Type Olnitial
0 Amendment El Termination—See Part 5 For official Lf5ly
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# # CITY OF RANCHO PALOS VERDES
AUG 2 0 2015
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Date qualified as committee Date qualified as committee Date of Termination
(If applicable)
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NAME OF COMMITTEE . E O R�ASURER
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I have used all reasonable diligence in preparing t - - atement and to the best of my knowledge the information contained herein`is true and complete. i•
penalty of perjuryunder he law - . p e. I certify under
p y s of the is that the foregoing is true and correct.
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Executed on ,i / By �'�
DATE URER OR ASSISTANT TREASURER
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DA E SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
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/ SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT #
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Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(Dec/2012)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
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Statement of Organization CALIFORNI
Recipient Committee FORM 410
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I.D.NUMBER
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• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER •
ADDRESS CITY STATE ZIP CODE
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Controlled Committee /1/
• 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." - •
• 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
0 Nonpartisan
0 Nonpartisan
• •
Primarily Formed Committee 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) CHECK ONE
SUPPORT OPPOSE
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• FPPC Form 41b(Dec/201.2)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov