CA Form 410 Termination Committee To Support Ken Dyda for Council 2015 Statement of Organization Date Stamp CALIFORNIA 41 0
Recipient Committee RECEIVED FORM
Statement Type 0 Initial 0 Amendment ® Termination—See Part 5 CITY OF RANCHO PALOS V IDES For Official Use Only
Not yet qualified ❑ or
List I.D.number: List I.D.number:
# # 1379423 JAN 2 9 2016
_________
/ / / / 12 /31 2015
Date qualified as committee Date qualified as committee Date of Termination CI TY CLERK'S OFF °
(If applicable)
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF TREASURER
Committee to Support Ken Dyda for Council 2015 David M Koch
STREET ADDRESS(NO P.O.BOX)
STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE
Rancho Palos Verdes CA 90275 (
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Rancho Palos Verdes, CA 90275 (
MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O.BOX)
FAX/E-MAIL ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
Los Angeles Rancho Palos Verdes David M. Koch
STREET ADDRESS(NO P.O.BOX)
CI1 Y STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
Rancho Palos Verdes CA 90275 (
3. Verification
I have used all reasonable diligence in preparing this - - ent and to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury nder the :ws of the State o , the foregoing is true and correct.
Executed on By /
CANDIDATE,OR STATE MEASURE PROPONENT
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(Jan/2016)
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www.fppc.ca.gov