240828 Form 410 Bhence 20249>
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Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Not formed to support or oppose specific candidates or measures in a single election. Check onlyone ba:
0 CITY Committee 0 COUNTY Committee 0 STATE Committee
PROVIDE OR NE DESCRIPTION OF AmNITY
list additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GREW OR AFFILIATION OT SPONSOR
STRPETADDRESS NO.. AND STREET CIN STATE 2IP CODE AREA CODEIPNONE
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5. Termirrartion Requirements By Spins the Stnficni on, the Treasurer, assistant tremurer a ndlorrandidate, odeoeholdr, or poient vortly thit &I of the I x4dam he
heto EYE;
• This committee has ceased to recenne 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 otherobligabores;
• This committee has no surplus funds; and
• The commithe has filed all campaign statements required by the Politcal Reform Act disdosing all reportable transactions.
— There are restrictions on the dispositran of surplus campaign funds held by elected 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 -
89519, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5
FPPC Form 410 (October/20231
FPPC Advice; advice(3fooaw.eov(866/2753772)
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