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� Recipient Commiitee <br /> Campaign Statement <br /> Cover Page <br /> (Govemment Code Sections 84200-84216.5) <br /> SEE INSTRUCTIONS ON REVERSE <br /> Type or print in ink. <br /> Statement vers period <br /> from <br /> through --��'�1�!l-�� <br /> 1. Type of Recipient Committee: All Committees-Complete Parb 1,z,3,er,a a. <br /> ❑ Officehoider,Candidate Controiled Committee ❑ Primarily Formed Ballot Measure <br /> Q State Candidate Election Committee Committee <br /> Q Recall Q Controiled <br /> (Also Comp/etePart 5) Q Sponsored <br /> (AlsoCompletePart 6) <br /> General Purpose Committee <br /> Q Sponsored � Primarily Formed Candidate/ <br /> Q Small Gontributor Committee Officeholder Committee <br /> Q PoliticalParty/CentraiCommittee (asocompereaerrn <br /> 3. Committee lnformation (�'D' <br /> COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) <br /> FRlENaS �� R�:t��0 ClTY pf�-G <br /> STREET ADDRESS(NO P.O. BOX) <br /> �75 /� 5'�r'��� <br /> Date of election if appii <br /> (Month, Day,Year) <br /> COVER PAGE <br /> Date Stamp <br /> _._.______--__.___.,�__ . <br /> •- <br /> �' S�� � � ���7 Page of <br /> For Of�cial Use Only <br /> 2. Type of Statement: <br /> ❑ Preelection Statement � Quarlerly Statement <br /> �emi-annualStatement � Special Odd-Year Report <br /> ❑ Termination Statement ❑ Suppiementai Preelection <br /> (Also file a Fortn 410 Termination) Statement-Attach Form 495 <br /> ❑ Amendment(Explain below) <br /> Treasurer(s) <br /> 0 <br /> 4. Veri�cation <br /> I have used ali reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the infor ation contained herein and in the attached schedules is true and cromplete. 1 certify <br /> under penalty of perjury under the taws of the State of Catifomia that the foregoing is trve and correct. <br /> Executed on �O�0 �� ( gy ' <br /> Date ignetureof reasurororAssistantTreasurer <br /> Exewted on <br /> D�e <br /> Executed on <br /> DaOa <br /> exeouted on <br /> Dete <br /> By <br /> Sigreture of Controlflng OfflceFiolder,Candidate,State Measure Proponent or Responsible Officer M Sponsw <br /> By <br /> Signedue oiConVdAng Olficeholder,Cendidete.Siete Measure Proponent <br /> ey <br /> Signahxe oi Conhnlling Officehdder,Can�6date,Sfale Measure Proponent <br /> FPPC Form 460(January/05) <br /> FPPC Toli-Free Helpiine:866/ASK-FPPC(866I275-3772) <br /> State of CaHfornia <br />