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


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

Please press 'Create PDF Documnet' button below. Filled out Form 400 PDF document will be opened. Please print the document and sign at the bottom of the page.

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