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,3takemf. nt of Organization WHERI~ TO FILI~! ~ ~7 ,~r. / t~ ~ ~ STAiEMEN1 OF <br />Real.Camm.tee , q] Flleodglnalandone;oPYOf~fO'mWItht / DateStamp <br /> SecTetary of State FlEQEIVED-'AHD FILEU <br /> <br /> Amendment 5Kramento, CA 95812-1467 <br /> ~Check box lf in Amendment And, lflppllcmble, file one copy of this form wlth:,I AUG 1 e 1995 AUG 1 <br />Type or print In ink I and enter I.D. number: The city or county officer, U any, who receives the <br /> I <br /> committee's original campaign disclosure JandJd~emd, ~alUio <br /> , statemenU. ~ ~i h~meq el ~btq , <br />SEE iNSTRUCTIONS OH REVERSE ' ' <br />I Committee Information II Treasurer and Other PrinciPal officers <br /> NAME OF TREASURER <br />Date Qualified as ~ Check box if not yet qualified LARRY A Z K~NS <br />Commi~ee ~omh, Dly, Yem) <br />NAME OF COMMI~EE MAILINGADDRESS <br /> 926 ~00OS~OE ROAD <br /> FRIENDS 0F ~TT LEiPZiG cRY STATE ZIPCODE AREA CODEIDRYTIME PHONE <br /> <br /> RDDRESSOFCOMMiTTEE(NOT~.O.~OX)NO. ANDSTREET REO~00O C~T~, CA ~4061 (415) 369-7331 <br /> <br /> ~ 580 EL CAI.I~N0 REAL.. , HAME AND POSITION OF OTHER PRINCIPAL OFFICER(S) <br /> <br /> CITY STATE' ZIP CODE AREA CnDEI PHONE HUMBER <br /> :SAH CARLOS, CA 94070 (41 ~5~R MAILING ADDRESS <br /> <br /> COUNTY OF DOMICILE i COUNTY WHERE COMMITTEE IS ACiIVE IF ~IFFERENT <br /> THAN COUNTY OF DOMICILE <br /> SAN ~ATE0 cRY STATE :ZIPCODE AREACODEIDAYTIME PHONE <br /> <br /> MAILING ADDRESS (IF DIFFERENT) ND.AND STREET OR P.O, BOX <br /> ~. 0 BOX ~8 Attach additional lnformation on appr°prla~ely labeled contlnuation sheers. <br /> STATE ZIP CODE AREA CODEI PHONE NUMBER <br /> ctT~ED~00D C~TY, CA 94064 (415) 599-3672 <br />iii ~isposition of Surplus Funds You must specify what disposition will be made of leftover campaign funds, il any, at termination. BONATE T0 CHARITY <br /> <br />i~ ~erification <br /> I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I <br /> ce~ify under penalty of perjury under the laws of the State of California that the foregoing is.~true and correct. <br /> <br /> DATE / CITY AND STALE ' ' - SIGNATURE Of TREASURER <br /> <br /> Executed on At By <br /> DAIE CITY AND STALE SIGNATURE OF COHIROLL~G OFFICEHOLDER, CANDIDAIL OR SIAIE MEASURE PROPONENT <br /> <br /> Executed on At By <br /> DATE CITY AHD SIATE SIGNATURE OF CONIROLLING OffICEHOLDER. CANDIDATE. OR SLATE ME ASURE PROPONE H1 <br /> <br /> Executed on At By <br /> DATE CITY AND SIAIE SIGNAIURE OF CONTROLLING OFEICEHOLDER, CANDIDATL OR STATE MEASURE PROPONENT <br /> <br /> ~oa I~FOnMA~tO~ aEOumEo TO BE PROVIDED 10 YOU PURSUANT TO mE tmORMAT~ON PRACTICES ACT OF t977. SEE INfORMATiON MANUAL OH CAMPAIGN DISCLOSURE PROVISIONS OF THE POImCAL NFORM ACT. <br /> State of California Fair Political Practices Commission <br /> <br /> <br />