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I <br />Officeholder, Candidate, Type 0, print inink. COVER PAGE-LONt~ r,., .... <br />and Controlled Committee Statement covers period DateStamp <br /> <br />Campaign Statement -- Long Form f,o~ ~ ~ ~ : <br /> (GovernmentC~eSe~ions84200-84216.5) 'hrou.h~ ' ~ ~ I~ ~ ~~ ~ <br />Check one of ~he followin~ ~xes to indiCate the type of statement ~ln~ filed: Dat~ of ~le~ion ~ applicable ~ ~e <br />~ Pre-eleOionStatement (Month. Day. Y,ar) lU[ ~ I Z~ For OfficialU,e Only <br /> Su,,lement. IPre-ele.ionS,a,e.ent(A. achacompleted,orm495tothiss,ate.ent.) ~/~' i <br />~ $~cialOdd-Yearcampaign Re~ ~ <br />~ Semi-annual Statement /~ <br /> ~ Term ination Statement CA. ach a completed Form A1 S to this ~atement.) <br /> ' ' ' II Other Committees I I0~ InclUded in this Statement: u,..~o~ <br />~?holder. Candidate. and Controlled Committee <br /> I n c l u d ed i n t h is State me nt commi~ees not included in this consolidated ~atement that are controlled by you a~ any <br /> NA~ OF OFFICEHOLDER OR ~NDIDATE comml~ees ofwhlchyou have knowledge that are primarily formedto receive contrlbutlom <br /> <br /> OFFtC[ 5OUGHT aA HELD (INCLUDE [~TION ~NDDISTEI~ NUMBER IF APPU~ <br /> AND STREET) NAME ~ T~ASUR[R CONTROLLED COMMI~[[ <br /> C~Y STATE ZiP CODE AREA CODE~AYTIME PHONE COMM~EE ADDRESS (NO. AND <br /> <br /> COMMITTEE NA~IE [I.D. NUM~ER C~Y SIAl[ ZIPCOD[ AREACOD[mAYIIM[ PH~[ <br /> <br /> I <br /> ~OMMI~[[ ADDA~ (NO. AND <br /> <br /> CffY STATE ZIP CODE A~A CODE~AYTIME PH~E NAME Of TREASURER CONTROLLED COMMI~EE <br /> <br /> NAME OF, TREaSURER / , , C~M~EEADO~SS (NO. AND ST~E~ . ', <br /> P[AMAN[~ ADD~E$~ ~ T~EA~U~[~ (NO. AND ~T~EET) ~y ~TA~[ ZIP (OD[ <br /> CffY STATE ZIP CODE A~A CODE~AYTIME PH~E <br /> <br /> I h:ve used a~l reachable diligence in prepa ring this statement. I have reviewed the statement and to the ~ of m~ ~owl~dge t~e~formation contained herein and in the a~ached schedules is <br /> ~ruc ~nd complete. I ce~if~ under ~nal~ of ~dury under the laws of ~tate of California that the foregoing isSUe a~d COr~e~/// ~ <br /> <br /> DATE ' CITY AND STATE ~' SlGNAIURE OF TREASURER <br /> <br /> An officeholder or ~ndldate who controls a commi~ee must also verify the campaign statement. I have used all reasonab~iligence and to the best of my knowledge the treasurer has used all <br /> rea~onabie diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge~e information contained hereto and in the a~ached schedules is true and <br /> complete. ~ce~ifyunder~na~ty~f~rju~underthe~aws~fthe~tate~fca~i~rniathatthef~re~in~istruea~rre~` / ~ <br /> <br /> DATE"' . ,n ~ J C~Y AND STALE / ~ / / /'~ SIGNATURE OF CANDIOATE/OFFIC[HOLDE~ <br /> <br /> DATE ; ~CITY AND STATE // / 'r ' SIGNATURE OF CANDIDATE/OFFICEHOLDER <br /> FOR iNFORMATION R[~tRED TO BE P~OVlDED TO YOU PURSUANT TO THE INFORMATION P~ICES A~ OF 1977, SEE INFORMAIlON MAN~AL ON ~MPAIGN DISCLOSURE PROV?LO[~} OF IH[ POLI11CAL REFORM AC1 <br /> <br /> <br />