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LONG FORM <br />Officeholder, Candidate, Typo or Prin, in Ink. Statomont covors poriod Dale Stump <br />and Controlled Committee <br />Campaign Statement -- Long Form from <br />(Government CoJc Sections 84200-842163) <br />SEE INSTRUCTIONS ON REVERSE <br />Check o.. o, ,he following box.. ,o indic.,. ,h. ,yp- o, .tat.men, b.ing ,ilod. <br />[] Pm-elecPo~ Statemenl <br />[] Supplemental Pre-eleclion Statement (Attach a compleled Form 495 to this slalemenl.) <br />[] Semi-annual Statement <br />~J~Terminalion Statement (Altach a completed Form 415 to Ibis stalement) <br />I Officeholder, Candidate, II Other Committees Not Included in this Statement: List a.~ other <br />and Controlled Committee committees not included in this consolidated statement that are controlled by you and any <br />Included in this Statement committees of which you have knowledge that are primarily formed to receive contributions or <br />~: F~,~'EHOt~R OR C~C~,I£: to make expenditures on beha~f of your candidacy. <br />omcE sa~m: <br /> <br /> ~ ~ I ~ ~' ./~JIATE ZIP CCY~E AR F..A COoE/eAYTiUE PHC~E COIvlMIITEE A[~RESS: {NO AND STREEt} <br /> <br /> COIvlMfrIEENAME:r. ~ ~ [ ~'~/ ~K~ J ,~ ~ . / / .,~ .~.~ I I.D. NUMI~R CITY STATE ZIPCO0~ AREACOI3CJDAYIIMEPHO~E <br /> <br /> COMMfrI'EE,ADI~ESS:/j 21 ,~ (NO:~___.~TI:~L:"[) ,/I <br /> A.> 7. <br /> CITY ~/ A L/f /~ ,..L_.STATE A ZIPCO~ CONiROLEDCOMIdlHEE~ <br /> <br /> ~ OF TRF..kSt,IRER: COIVMITTEE A[N~RESS: (NO. ~ STR£ET) <br /> PERMANENT ADORF..~ OF TREASU~Efl: (NO. ANO STF~ET) CITY STATE Zl~ COO[ AREA CODEJOAY11ME PHO~IE <br /> CiTY STATE ZF COO[ A~E~,CO~rr.~AY]'IM[ ~ <br /> <br />Iii Verification Officeholder or Candid~t~: <br />Treasurer: ! have used ali rcasoaabl¢ diligence a~d ~ thc best of m~ knowledge the I~casurcr has <br />I have used ali reasonable diligence in preparing this sla~cmcm a~d to ~c hest of my used all rcasonablc diligence i~ preparing this slatcmcnt. I have reviewed thc slam- <br />knowledge Ibc in[ormatioa contained herein a~d in ~ auachcd schedules is ~ru¢ and ment and to thc bcs~ of my knowledge thc in[ormatioa contained herein a~d in the <br />c. orap. l¢~. I cc .nify.undcr pe?dty of perjury under thc laws eT thc $la1¢ eT California atlached schedules is line and complete. <br /> tirol tl~ lorcgo,n.g ~s true aha correct. . ~ laws of thc Slate of Ca$ifomia that thc[~rcgo~g is truc and/~?c-~ /// <br /> <br /> V Slalo el Calilorn'~. F.ir Polilic.I Praclic®~ Commi~ion. <br /> <br /> <br />