Fppc Form 410 - Statement Of Organization - Recipient Committee Page 4

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Statement of Organization

410

CALIFORNIA

Recipient Committee

FORM

InSTRuCTIOnS On ReveRSe

Page 2

COMMITTee nAMe

I.D. nuMBeR

• All committees must list the financial institution where the campaign bank account is located.

BAnk ACCOunT nuMBeR

nAMe OF FInAnCIAl InSTITuTIOn

AReA CODe/PHOne

CITy

STATe

zIP CODe

ADDReSS

4. Type of Committee

Complete the applicable sections.

Controlled Committee

• 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 CAnDIDATe/OFFICeHOlDeR/STATe MeASuRe PROPOnenT

(InCluDe DISTRICT nuMBeR IF APPlICABle)

eleCTIOn

CHeCk One

nonpartisan

Partisan (list political party below)

nonpartisan

Partisan (list political party below)