HomeMy WebLinkAbout410 - 12/29/2022_ Redacted (TJH)Statement of Organization
Da= -
Recipient Committee
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Statement Type []initial ❑ Amendment
® Termination — See Part 5
For Official Use Only
O Not yet qualified
DEC 2 9 2 22
or
O Date qualification threshold met Date qualification threshold met
Date of termination
—1
12 t 28
Committee1. • I.D. Number 14532452.
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Treasurer and Other
NAME OF COMMIITi
Committee to Elect Tracy Jensen Han to Arcadia City Council, 2022
NAME OF TREASURER
Raymond Jensen
STREET ADDRESS (NO P.O. BOX)
9851 Dairies Ave
STREET ADDRESS IND P.O. BOX)
CITY
STATE ZIP CODE AREA CODE/PHONE
520 Cortez Road
Temple City
CA 91781
CITY STATE ZIP CODE AREA wNIONQ NE
NAME OF ASSISTANT TREASURER, IF ANY
Arcadia CA 91007 (323) 828-9540
FULL MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
E-MAILADDRESS(REQUIRED)/FAX(OPTIONAL)
CITY
STATE ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
NAME OF PRINCIPAL OFFICERISI
STREET ADDRESS (NO P.O. BOX)
Attach addltional information on appropriately labeled continuation sheets.
3. Verification
CITY
STATE ZIP CODE AREA CODE/PHONE
I nave used all reasonaole aingence in preparing misstatement and to the D of my Knowledge the inrarmadon contained henem is true anti W mplete. I canary under
penalty of perjury under the laws of the State of C Ifornia that a fo �i g true and correct.
Executed on 12/28/22 ey
DATE GNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on 12/28/22
By
DATE SIGNA F.OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on gy
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 (August/2018)
FPPC Advice: advicerafooc.ca.eov (866/275-3772)
www.fooc.ca.gov