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Officeholder, Candidate, Type or print in ink. COVER PAGE- LONG FORM <br /> · Statement covers period '~-'- St~mp <br />and Controlled Comm,ttee . ,_ <br />Campaign Statement -- LongForm f,om ~/.,~~~ <br />(Government Code Sections 84200-842165) ,,~ -., _/~/ I1' <br /> through~l II MM~..,... IUIIll <br /> SEE INSTRUCTIONS ON REVERSECheck one of tbe following hoxes to Indicate the type of statement being filed: Date of election if applicable: I' <br /> r"J Pre-electionStatement (Month, Day, Year) I L.,~.~,~.,.,~I I ForOfficielUseOnly <br /> [] SupplementelPre-electionStatement(AttachacompletedForm495tothisstatement.) J <br /> r-I SpecialOdd-YearCampaignReport _ ~ ~. ~"! I {~IYCI. ERK I I <br /> ~ Semi-annual Statement I' /~/m ~ c~.~ ~ <br /> Termination Statement (Attach i completed Form 415 to this statement ) -- I I <br />I, Officeholder. Candidate, and Controlled Committee II Other Committees Not Included in this Statement: LIstenyo~er <br />Included in this Statement commttteesnotincludedin thisconsolidatedstetement fha! ere controlled by you andeny <br />NAME OF OFFICE HOLDER OR CANDIDATE camm/trees of which you have knowledge that ere primarily formed to receive contrlbutiom <br />~:)~(,~ /~/~/~/ 'C~/~ /, / ~~ ortomeke expendi~ure$onbehalfofyourcendi(M,. <br /> <br /> C-/L,{ , 'e woo 7' <br /> <br /> NAME OF TREASURE R CoMMnTEE ADDi~ESS (NO. AND STREET) <br /> <br /> fqo7a <br />III Verification <br /> I here used ell reasonable diligence in preparing this statement. I have reviewed the statement end to the best of my knowledge the informetion contained herein and in the attached schedules is <br /> true ond complete. I ~:erUfyJInder penelty ot Perjury under the law~ of the State of Celilornia that the foregoing is. tM~l nd correct..m <br /> <br /> cnY ANO STATE -- / SIGNATURE OF TREASURER <br /> An officeholder or candldete who controls a committee must also verify the campaign statement. I have used ell reasonab~ediligence and to the best of my knowledge the treasurer has used ale <br /> reasonable diligence in prepa~ieg this statement. I here reviewed the statement end to the best of my knowBedge the information contained herein.and in the ettached schedules is true end <br /> cam plete. I ce r~ify under penalty of pe ,jury under the lews of the State of CeEfornie that the foregoing is true a nd cM'rect. <br /> <br /> Executed on At By <br /> D~TE aTY AND STATE S~GNATUe, E O~ CAN~OAT~Or~KEH(XOE~ <br /> Executed on At By <br /> OAr[ cnY AND STArt S~GNArURS O~ <br /> <br /> <br />