Form 400 - Statement of Organization (Slate Mailer Organization)


(Government Code Sections 84100, 84101, 84103, 84104, 84108)

Form 400 Instructions


Please Check one box to indicate the organization's level of activity:



File original and one copy of this form with:

Secretary of State
Political Reform Division
1500 11th Street, Room 495
Sacramento, CA 95814

Amendment




Date Qualified


Part 1 of 5: Slate Mailer Organization Information












Part 2 of 5: Treasurer And Other Principal Officers

First Officer




Second Officer




Third Officer




Fourth Officer





Attach additional information on appropriately labeled continuation sheets.



Part 3 of 5: Individuals Who Authorize Contents of Slate Mailers


First Individual




Second Individual




Third Individual




Fourth Individual





Attach additional information on appropriately labeled continuation sheets

Part 4 of 5: Is This Organization A "Committee" Pursuant to Government Code Section 82013?





Part 5 of 5: Verification

I have used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct





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End of the Page California Form 400 Statement of Organization - Slate Mailer Organization