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Officeholder, Candidate, Typeo, printinink. COVER PAGE* LONG FORM · <br />and Controlled Committee Statementcoversperiod <br />Campaign Statement -- Long Form *om / - /- <br />(GovernmentCode Sections 84200-842,6.5) ~mugh ~ <br />5E£ INSTRUCTIONS ON REVERSE Dateo~onlfappltcable:ii 47 ..... dllt 'F /-'"' <br />Chack one of tbe following boxes to indkate the type of statement being filed: <br /> <br />Suppiemantal ~re.-~l~Ktion Statement IAi:ach ~ completed Form ~gS to this statement.) <br />I~] Semi-annuaIStatement I <br />~ Termination Statement (Attach ~ completed Form al 5 to this statement.) <br />I, O~Ticeholder. Candidate. and Controlled Committee II Other Committees clot inuuueu m ~,;a ~.~ ;ment: uston~other <br />In eluded in this Statement comm/~tees not includedin this conso//da ted state merit that a~e controlledbyyou and any <br /> corem/trees of which you have knowledge that are pdmarl/y formed to receive contributions <br /> NAME CJ~ OFFICEHOLDER OR CANDIDATE <br /> <br /> I <br /> <br /> COMMITTEE NAME I,O, NUMIER ~ STATE Z~ CO[~ <br /> <br />III Verification <br /> I hive u~d ~11 reachable diligence in preparing this ~tement. t have review~ the statement and to the ~fl ot m~ledge the information con~inCe~in and in the a~ached <br /> true ind ~ompl~. I ce~i~ under ~na~ of ~rjury under the laws of the $~te of California that the ~r~oing~ corrffi. ~ /~/ <br /> <br /> ~TE CnY AND STATE / S~NATURE M TREASU~R <br /> <br /> An officeho~u M ~Mate who contrMs a corn m~ must also verify t~ campaign s~teme~. ~ have u~d all reasonable diligence a nd to the ~ o~ my knowledge the treasurer has used all <br /> rea~nable diligeKe in pre.ring this statement. I have reviewed the statement and to the ~ of my kn~dge the information contain~ herein and in them~ch~ Kh~ules is true and <br /> corn plete. I ce~i~ under ~na~ o~ ~rju~ under the laws of the State of California ~hat the ~oregoing is true and corre~/ <br /> <br /> Executed on At By <br /> <br /> <br />