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Reci ient Committee Oate Stam COVER PAGE <br /> p Type or print m mk P �I <br /> Campaign Statement � �� � � • � <br /> Cover Page ������� <br /> ' (Govemmenl Code SeGions 84200-84216 5) page � of_� <br /> Statement covers period Date of election rf app�lc le <br /> �, ► 2� ' � (Monih, Day Year) AUG 2 2011 r Offiael Use Ony <br /> from I �� <br /> SEE INSTRUCTIONS ON REVERSE through � � � I I CITY OF REJVs�00D CIT <br /> 1 Type of Reap�ent Committee All Commltteea-Complete Parl51,z,a,and 4 2 Type of Stateme <br /> ❑ Oficeholder,CandWale Controlled Committee ❑ Primany Formed Ballot Measure ❑ Preeled�on Statement � QuaAerly SWtement <br /> Q State Candidate Eleclion Committee Committee �emi-annual SYatement � Speaal Odd-Year RepoA <br /> 0 Recall Q Controlkd � Tertninahon Statement � Supplemental Preelechon <br /> (arsocomyeroaans� Q Sponsored (Also file a Fofm 410 Termmation) Sletement-Attach Form 495 <br /> (AlsoCampkfePartB) <br /> , General Purpose Commitlee ❑ Amendment(Explain below) <br /> Q Sponsored ❑ Pnmanly Formed Candidate/ <br /> Q Small ContnbutorCommitlee Officeholder Commrttee <br /> QPoltlicalParly/CentralCommMee ����d�Pdn� <br /> 3 Committee Information �o NUMBER I Z� � Treasurer(s) <br /> COMMITTEE NAME(OR CANDIOATES NAME IF NO COMMITTEE) NAME OF TR SURER �� / <br /> �U !ti t <br /> � MAI ING AD�RESS ( <br /> ��l�iu�S 0� �1�� � � 1 � �-�S � �.l � <br /> S��S RESS(NO P � K� � `�-v"i�� �C� v. +� ��J IUIJIIARJ��E/P�NE � <br /> rn t <br /> C17y , 5T ZIP CODE AREA COOE/PHONE NAME OF ASSISTANT TR SURER IF ANV <br /> ([.eYi��„��G�� G� ���3 foS� -3(��3�Z-�= C �¢. u�- <br /> MAILING ODRESS (IF DIFFERE n NO AN� STftEET OR PO BOX 6� 3�! S MpILING DD 5 <br /> �,0, �csn 8 S3 `y'— / `l� 3?o vvt S�e�-�- <br /> 1"l.!'i��A(�N� Gr� CT� � 1��0 1'IlSS�ACODEIPHONE K('J. ll�� � �� �HA?E r,. ?O��E �O�AR��(I �P _IN�-Z� 1 <br /> '1`1 <br /> OPTIONAL FAX/E-MAII AD RESS OPTIONAL FA%I E MAIL ADDR S <br /> 4 Verificat�on <br /> I have used all reasonable diligence in prepanng and revie�+nng fh�s statement and to the best of my knowledge the intormat�on co tained herein and in the attached schedules is true and complete I ceAify <br /> underpenalryofpequryun erthe wsoftheSlateofCa6fomiathatlheforegoirg�strueand rred <br /> � L9 Z.o /� v_ <br /> Execuledan � By , SIBiu�ure reasuraror0.csislant easurer <br /> Ezecutedon �� 8y sgne4veorConboUrqOlAwlrokbrCaMkafa,Sl+bMeaswaPmponontoraaspon�daOlAcermsW^o� <br /> FJCxuted on � BY SlgnenaeolCOnlmlu(qOlfiranoWer Cantlltlem smteMeesurePivpa�q <br /> E%eeuted On p� BY SgrreNrealCaMrdfagOfiahdtlar CanGtlala SlateMeasweProporent <br /> FPPC Form 460(Januery106) <br /> FPPC Toll-F�ee Helpline 0861ASK-FPPC(8661276 7772) <br /> Stete ot Celitornla <br />