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« <br /> ' Recipient Commitbee <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 covers period <br /> from �l%! .3�l�� <br /> through 1rf��3 I�D� <br /> 1. Type of Recipient Committee: All Committees—Complete Parts 1,z,s,e�a a. <br /> ❑ Officeholder,Candidate Controlled Committee ❑ Primarily Formed Baliot Measure <br /> Q State Candidate Election Committee <br /> Q Rerall <br /> (Also Compfete Part 5) <br /> �General Purpose Committee <br /> Q Sponsored <br /> Q Small ContributorCommittee <br /> Q Political Parly/Cer�tral Committee <br /> 3. Committee lnformation <br /> Comm�ttee <br /> Q Controlled <br /> Q Sponsored <br /> (Aiso Canplete Part 6) <br /> � Primarily FoRned Candidate/ <br /> O�ceholder Committee <br /> (Also Complete PaR n <br /> I.D. NUMBER <br /> COMMITTEE) <br /> �R►Erv�s oF R�au�c�Q c�T y (�A-� <br /> Date Stamp <br /> � � �� u 14� <br /> COVER PAGE <br /> of <br /> Date of election if applicable I � 0 2�08 ' <br /> (Month, Day,Year) ,J A N For otficial use Ony <br /> CITY OF ficDWOC)D .�'•1T1` <br /> CIiY CLF_RK <br /> 2. Type of Statement: <br /> ❑ Preelection Statement � Quarterly Statement <br /> [V�Semi-annual Statement � Speciai Odd-Year Report <br /> ❑ Termination Statement ❑ Supplementai Preelection <br /> (Also file a Form 410 Terminationj Statement-Attach Form 495 <br /> ❑ Amendment(Explain below) <br /> Treasurer(s) <br /> �.�6 ,,�}l�l�� 5"t�� �- <br /> C�TY n , _ , STATE ZIP CODE ' AREA CODEIPHONE <br /> FAX I <br /> 4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the inform ' n contained herein and in the attached schedules is true and complete. I certity <br /> under penalty of pe�jury under the laws of the State of California that the foregoing is true and coRect. <br /> Executed on�.(� BY < <br /> p� 5ig reofTre rorAssistantTreasurer <br /> Executed on <br /> Dare <br /> Executed on <br /> Dete <br /> Erecuted on <br /> Date <br /> By Signature of ControtNng OHicetwlder,Candidete,State Measure Proponent w Respor�ible Offieer of Sponsor <br /> By <br /> Signet�re W Contrdhng Officeholder,Cand�dete,State Measure Proponanf <br /> By <br /> Signalure otCoMrdGng OfAceholder,Candidate,State Measure Proponent FPPC Fomt 460(JBnuary105) <br /> FPPC Toll-Pree Helpline:866IASK-FPPC(866/276-3772) <br /> State of California <br />