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 ❑ 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 CITY 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)
5714 Wildbriar Drive
ST OX) CI7 Y STATE ZIP CODE AREA CODE/PHONE
5714 Wildbriar Drive erdes CA 90275 (949)678-5777
CITY ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Rancho Palos Verdes, CA 90275 (949)678-5777
MAILING A FERENT) 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)
5714 Wildbriar Drive
STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
Rancho Palos Verdes CA 90275 (949)678-5777
3. Ver
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 y„a.lif t the foregoing is true a
Executed on By - 4r f-ar ,,,r.
Al F
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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