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__~. __.,r)fficeh~lder, Candidate Typeor print in ink. '.OVER PAGE- LONG FORM 'and Controlled Committee Statemen, covers.~,,o, o...s... 490 Campaign Statement - Long Form from 10/22/95 1994 FORM (Government Code Sections 84900-84216.5) SEE INSTRUCTIONS ON REVERSE through 12/31/95 Page 1 of 7 Check one of the following boxes to indicate the type of statement being filed: Date of election if ~ 3 I ~ For Official Use Only [] Pre-election Statement (Month, Day, Year) I--"1 Supplemental Pre-election Statement (Attach a completed Form 495 to this statement.) [] Special Odd-Year Campaign Statement [] Semi-annual Statement 11/07/95 ~ Termination Statement (Attach a completed Form 415 to this statement.) I Officeholder Candidate, and Controlled Committee II Other Committees Not Included in this Statement:List any other Included n th s Statement committees not included in this consolidated statement that are controlled by you and NAME OF OFFICEHOLDER OR CANDIDATE any committees of which you have knowledge that are primarily formed to receive Matt Leipzig contributions or to make expenditures on behalf of your candidacy. OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) COMMITTEE NAME I I.D. NUMBER I Redwood city city Council RESIDENTIAL OR BUSINESS ADDRESS (NO. AND STREET) 580 E1 camino Real NAME OF TREASURER CONTROLLED COMMITTEE? CITY STATE ZIP CODE AREA CODF_./DAYI'IME PHONE [] YES [] NO COMMITTEE ADDRESS (NO. AND STREET) San Carlos CA 94070 (415)593-5888 COMMITTEE NAME ~ I.D. NUMBER Friends of Matt Leipzig I CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE COMMITTEE ADDRESS (NO. AND STREET) 951036 COMMITTEE NAME I I.D. NUMBER I 580 E1 camino Real CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE NAME OF TREASURER CONTROLLED COMMITTEE? San Carlos CA 94070 ( 415)562-3565 DYES []NO NAME OF TREASURER Larry Aikins COMMITTEE AODRESS (NO. AND STREET) PERMANENT ADDRESS OF TREASURER (NO. AND STREET) 926 Woodside Road C~TY STATE ZIP CODE AREA CODE/DAYTIME PHONE CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE Redwood City CA 9 4 061 ( 415 ) 3 6 9-73 31 Attach additional information on appropriately labeled continuation sheets. III Verification I have used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complote, lcertify undor penaify of perjury under tho laws of the State of Californ,a that tho forogo'ng is truo and ~Executed on f~l ..---~'/~ At /~,~C~~ ' " ~"~"/ C:-yN By ~ ~-----~"~? ~'~ ~'~ DATE CITY ANd STATE SIGNATURE OF TREASURER An officeholder or candidate who controls a committee must also verify the campaign statement. I have used all reasonable diligence and to the best of my knowledge the treasure.r.~sed all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained h~in and i,~the attached schedules i.,.~e~nd complete. I certify~under I)enalty of perjury un_der trw laws of. the Sta_te qf California that,the foregoing is true and correct. /, · I~ATE - CITY ANO~TAfE - ' - S~NATURE OF ~DAT~ICE~R Executed on At By DATE CITY AND STATE SIGNATURE OF CANDIDATE/OFFICEHOLDER Executed on At By DATE CITY AND STATE SIGNATURE OF CANDIDATE/OFFICEHOLDER FOR INFORMATION REQUIREO TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLITICAL REFORM ACT. State of California Fair Political Practices Commission.