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p� Type or print in Ink. a e tamp SHORT FORM � Reci ient Committee Campaign Statement- sno� Fo�„ RECEIVE � • . � � � SEE INSTRUCTIONS ON REVERSE Sta�ment covers period Date of electlon if applicab : For use by recipient committees that have not received a I _ Z.v f Z (Month,Day,Year) JAN 3 0 2013 Page of � contribution or other receipt that must be itemized,have not from � ' For dai uae onry received or made loans,and have no outstanding acxrued �Z _3� . z � � L CITY OF REDWOOD C expenses. through ��'r(CLERK 1. Type of Recipient Committee: 2. Type of Statement: ❑ Ballot Measure Committee (�Gene�ai Purpose Committee ❑ Pre-election Statement ❑ Quarterly Statement Q Primarily Formed Q Sponsbred Q Controlled Q Small Contributor Committee �Semi-annual Statement ❑ Special Odd-year Report Q Sponsored ❑ Termination Statement ❑ Suppiemental Pre-elec�ion Stateme�-Attach Form 495 p Primariiy Formed Candidate/ ❑ Amendment(Explain) � Officeholder Committee (A�so cnec�c ry�e of s�atemern you are amendin9> 3. Committee Information �•D.NUMBER Treasurer(s) f z G�(� G�(�� COMMITTEE NAME NAME OF TREASURER �✓' ,� .� 1'!�( Cf � �!'1 r!a �-��C�.L ,/ � H ,�" � � /�� MAILINGADDRESS f"�/ � P L ) C) �-- K�Gt'w J U G C( � /�� 7 5 � S'�r�..�f' STREETADDRESS(NO P.O.BOX) ��Ty STATE ZIP CODE AREA CODE/PHONE Z�� '� S f'�t t / � ! G;S-v .�� -1�; C�N STATE ZIP CODE AREA CODE/PHONE �'��`'``rf 4� � c"4 y y��:�> � ' �� NAMEOFASSISTANTTREAS RER,IFANY k��'w��:�( C� � �.9 �IY�l�3 < Sz�f��l0�;-3�z�� C �� tG� � �`L� ��. MAILING ADDRESS(�F DIFFER N�NO.AND STREET OR P.O.BOX MAILING ADDRESS �'.�� I�'�� Sf�e-�. � CITY STATE ZIP CODE AREA CODElPHONE ��Ty STATE ZIP CODE AREA CODE/PHONE 1?�G�'r,��E-� �,� c,�1 yy�s j �s�/3c.1��`'� OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-AAAIL AD RESS 4.Verification i have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein is true and compiete. i certify under penalty of perjury under the laws of the State of California that the foregoin�q�is rue and corre . Executed on � ' ��— � /�3 � gy �%� ti�` �.(;,�� 'f � DATE IGNATUREOF EASURERORASSISTANTTREASURER Executed on gy DATE SIGNATURE OF CONTROLUNG OFFICEHOIDER,CANOIDATE,STATE MEASURE PROPONENT,OR RESPONSIBLE OFFICER OF SPONSOR Executed on gy DATE SIGNATURE OF CONTROLUNG OFFICEHOLDER,CANDIDATE,STATE MEASURE PROPONENT Executed on gy �ATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIQATE,STATE MEASURE PROPONENT FPPC Form 450(January/OS) FPPC 7oil-F�ee Helpline:866/ASK-FPPC(886/275-3772)