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/'t~l~;~-~'ld'tl~,r ~".'ln/~;~l.'lt~ TypeMpcintlnink. COVER PAGE - LONG FORM <br />Campaign Statement -- Long Form /~. <br /> <br />SEE INSTR~ION$ ON REVERE <br />[] ,,...~.ct~;t.t.,...t I ~Mo,~D..v..,I ! I I I'-~1 ............ ' I <br />r~j SupiMemental Pre-el~'~k)n Statement (Atlich i completed Fo~m 495 to this statement,) <br /> <br /> [] hmi-~nnualStitement I l ( / ~./ ......... j <br /> <br /> Included Jn ~is S~te~nt . <br /> NAME O~.DFRC, E~I OR Ti J CMmliffees of MMch you lt~ve knowied~ th~t are pffm4My fofl~d ~o recelw coMdbiW4)~ <br /> <br /> NAME OF TREASU~R /,~ /~ CoMMmT; ADOm$$ IW). ANO STMET) <br /> <br />III Verification <br /> I bin u~d III rilsoflibil diligenceln i~epering this statement. I haw reviewed the statement end to the best of my~owlidge the InfMmltiofl c~ntJined herein lind in the ittKhed sch~clulis is <br /> tr,Je end com~l~e.)l c~rtJ~Y t~nc~e~ r Olnllt7 Of PIJ~Y under the~Mvs o~ trw Stlte ~ ~lJ~n~ ~t t~ f~ ~r~. <br /> Executeclon~ At,~-''/''~ ~ ly - <br /> / IPAT! CiTY I STALE ~ / ~Gli~,t*U~s~ OF T~EASU~ItR <br /> <br /> An Mfl(ehoMer M clndidlte who comrds I commlttfl must lbo verify the cimpalgn ~mem. I have used all reisonaW diligence and to the best of my knowledge the treBsurer his used iii <br /> relsonlble dil~ence in preparing this statement. I hive reviewed the stltement ifld to the best of my knowledge the information contained herein mhd in the ~ttKhed schedules ~s t;ue ~nd <br /> complete, t certify under pemdty of p~rjury under the laws of the Stlte of Cidifomia th,t the foregoing is true Ind co~., <br /> <br /> * DATE f ' ' -- CITi AM) S~'ATi <br /> Executed on ' At By <br /> <br /> Executed on At By <br /> It)AT! <br /> <br /> FO~ INf QflMATION MQUI~D TO BE FIOVI~O TO YOU P4J~SUANT TO THE INF(~MATK)N P~ACTICE S ACI O~ tilT, SI[ INFORMATION MANUAL ON C~MPAIGN D~)CLOSU~ PROVI~MONS O(c TH~ P(~fTICAL ~FO4M AC? <br /> <br /> <br />