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Officeholder, Candidate, ~y~.o~ print tn Ink. COVER PAGE- LONG FORM <br /> <br />and Controlled Committee stata...t,o,.,sp.,~d Date Stamp <br />Campaign Statement -- Long Form ~,o./[/4o ~ ¢/' <br />(Government Code Sections~4200-84216.5) ~ ' ~ <br />,E,/N,TRUCTIONS ON REVERSE ,h.~ ~;~'~ ~f <br />C~ ~ ~ ~ f~l~ ~xes to I~klta h ~ d statement ~1~ fl~: Dill ~ ei~ J I~J: ~ffkill U~ Only <br /> Pre~l~n Statement (~ Day. <br /> $upp~men~l PrHl~<n S~tement (A~ch I ~p~tad Form 495 ~ this stltement.) F~ <br /> <br /> Semiannual S~tament / ] <br /> Terminati~ Statement (A~ach I com~ ~m 415 to this ~atement.) <br /> ~nt: <br /> In C ~is S~te~nt ~m.~ ~ ~1~ <br /> NAME ~ Off~Efl~R ~ ~ATE <br /> <br /> clW <br /> <br /> COMMI~ ~E .......... b~ ~ I ~.~Ul ~ STAll ~C~ <br /> c~/z/c~ i~ Fz~'~/ w~ ~-' I <br /> <br />Ill VerificatiOn <br /> I have u~d ell reasoneble diligence in I~eParing this statament, I have reviewed the statement and to the best of my k~6wled~he,lnh~matlofl contained herein and in the ettached schedules is <br /> true a~ corn piete. I certi~ under penalty of pg~ rJu_ry unde~the leM.~of the S~te of Calitmnia that the fo~ego~n9 is trd4~a~,nd c.,otret~t~. / 4~/~.~ ~ ,* <br /> <br /> An offkeholder m c~nclidate who controls I committee must IIu) verify the campaign statement. I have used ell reasonable diligence end to the best of my knowledge the treasure~ has used <br /> reasonable dihgence in p~eparing this statement. I have reviewed the statement and to the best of my knowledge the i..flto~m~on contpined herem and in the attached schedules is t~ue and <br /> ~om~at~. I cavity under penal~yof perju~ under the lews~of the State of Cllifornia that the foregoing is true end ccFfjlkt. / * /~ /~/', <br /> <br /> DAli CITY A/NO STAll ///~ SIGNAI UI~I Ot CANDIDA ll/O~l I(IHO(DI R <br /> <br /> <br />