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f Re�cipient Committee <br /> Campaign Statement <br /> Cover Page <br /> (Govemment Code Sections 8420Q-84216.5) <br /> SEE INSTRUCTIONS ON REVERSE <br /> Type or print in ink. <br /> Statement covers period <br /> from l"l' -- � c� G� <br /> through ��' ��x ��'�� <br /> 1. Type of Recipient Committee: Alf Gommittees-Comptete Parts 1,z,3,and 4. <br /> ❑ Officeholder,Candldate Controlied Committee ❑ Primarify Formed Ballot Measure <br /> Q State Cand'+date Etection Committee Cammittee <br /> Q RecaN Q Controlted <br /> (Arso Camp�ete Part 5) Q Sponsored <br /> (Also Completa Part 6) <br /> [�General Purpose Committee <br /> Q Sponsored ❑ Primarify Formed Candidate/ <br /> Q Smail Contributor Committee Officshoider Committee <br /> Q Polificai Party/Central Committee (A1so Comptele Pert 7j <br /> 3. Committee Information I I.O. NUMBER � ������ <br /> COMM{TTEE NAME(OR CAPSDIDATE'S NAME IF NO COMMITTEE) <br /> . <br /> �i�r,�v�t.�s a�� ��C�UJ-+x�c� �t� ��� <br /> S7REET AQDRESS(NO P.O.BOX) <br /> 2"%.�' � S�'��-�� <br /> CITY STATE ZiP CODE AREA CODE/PHONE <br /> t���� �,�'�i�, � ��p�p 3, �b°���rj-3t�o� <br /> t° � i <br /> MAtLiNG ADDRESS(IF DiFFERENT)NO.AND SiREEr oK r.u.��� <br /> �. c� � ��� �S� <br /> CITY STATE ZIP GODE AREA CODEiPHONE <br /> ��c,�1��� ��J _._ G� �`-�oCo`�~-o�5 3 <br /> FAX 1 <br /> Date of election if appt <br /> (Month, Day,Year) <br /> Date Stamp <br /> ,�,';� � � �.�'�� <br /> COVER PAGE <br /> � of � <br /> For Offidai Use Only <br /> - � � <br /> ' t �...�'t ' � �'�;ai��. <br /> ' "' — <br /> 2. Type of Statement: <br /> ❑ Preefection 5tatement (� Quarteriy Statement <br /> [r�"'Semi-annuai Statement [] Speciai Odd-Year Report <br /> ❑ Termination Statement ❑ Supptemental Preelection <br /> (Also file a Form 41 Q Termination) Statement-Attach Form 495 <br /> ❑ Amendment(Explain belowj <br /> Treasurer(s) <br /> NAME OF TREASt3RER <br /> ��-f--1�- �t.c�� �.. �r,(�.� <br /> ,..,,,�.,............_�.. � <br /> 2�1�°" :� ��s��- <br /> CITY S7ATE ZIP COE7E AREA COOE/PNONE <br /> `�..��,w��� �c�*-� � �`�O�Ca� t`�S°t�- �(�(r�--3`��,� <br /> � �� �c.�.y �—L�. �G,v�,r-t-. --- <br /> MAILING ADDRESS <br /> 3 3 v � t c��� �-�-r�.�.�-- <br /> G <br /> CITY S7ATE ZiP CODE AREA CODE/PHONE <br /> �P�t�a� �.�t� � ��d� 3 %�� �' ,��i r��'"i�-� <br /> OPT10 AlN : FAX/E-MA(L ADDRE S �� <br /> 4. Verification <br /> i have used all reasanabie diligence in preparing and reviewing this statement and to the best of my knowiedge the information contained heretn and in the atteched schedules is true and complete. i certify <br /> under penalty of perjury under the laws of the State of Cafifomia that the foregoic�g is true and co�rect.� , � J � <br /> Execuied on ( � �' �� 7'�d ° <br /> Date <br /> Executed on�— –�� <br /> Executed on � <br /> ExeCUted on Date <br /> ey <br /> or <br /> By Signature ofControNiny C7fNcehotder,Candidste,Stete Measure Proponent or Responsib�e Otficer of Sponaor <br /> By Sipnatu�a ofControiNnp 0lrioehotder,Candidete,State Meaaure Proponerrt <br /> � SignatureofCantroNingOf�ceholdar,Candidate.StateMeasurePropanent pppC Form 460(Janueryf05i <br /> FPPC Toit•Free Hetptine:866/ASK•FPPC(886/2TS-3T72) <br /> State of California <br />