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Officeholder, ..a n.,.ute, Ty,. or print in ink. ~ -- COVER PAGE- LONG FORM and Controlled Committee Statement ¢overs period DateStamp Campaign Statement -- Long Form from 01/01/96 (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE through 6/3 0/96 Check one of the following boxes to indicate the type of statement being filed: Date of election if applicable: Page of I-1 Pre-election Statement (Month, Day, Year) For Official Use Only [] Supplemental Pre-election Statement (Attach a completed Form 495 to this statement.) [] SpeciaIOdd-Year Campaign Report R Semi-annual Statement Termination Statement (Attach ii corn plated Form 415 to this statement.) I, ~)fflceholder. Candidate, and Controlled Committee II Other Committees riot Included in this Statement: u.a.yother Included in this Statement committees not included in this consolidated statement that are controlled by you and any NAME OF OFFICEHOLDER OR CANDIDATE comm/ttees of which you have knowledge that are primaril~ formed to receive contributions or to make expenditures on behaff of your candidacy. Matt LeiDzi~ COMMITTEE NAME I I.D. NUMBER OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) I RESIDENTIAL OR BUSINESS ADDRESS (NO. AND STREET) NAME OF TREASURER CONTROLLED COMMITTEE/ CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE COMMITTEE ADDRESS (NO. AND STRELrr) San Carlos CA 94070 593-5888 COMMITTEE NAME I I.O, NUMBER CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE I friends of Matt Leipzig 1951036 I COMMITTEE NAME i COMMITTEE ADDRESS (NO. AND STREET) I I.D. NUMBER 580 E1 Camino Real I CITY STATE ZiP CODE AREA CODE/DAYTIME PHONE NAME OF TREASURER CONTROLLED COMMITrEE? San Carlos CA 562-3565 [] YES NAME OF TREASURER COMMITTEE ADDRESS (NO. AND STREET) Larry Aikens .. PERMANENT ADDRESS OF TREASURER (NO. AND STREET) CiTY STATE ZiP CODE AREA CODE/DAYTIME PHONE 926 Woodside Road CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE Redwood City CA 94061 369-7331 , 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 toque best ~ knowledge the informa, t~Rcontained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the fl~lgoji~ll~tr~ct./I Executedon August 23, 1996 At Redwood City, CA 94063 DATE ' ' CITY AND STATE j· ~ ' S,%N~"ATURE OF~TREASURER An officeholder o~ oandidate who controls a committee must also verify the campaign statement.j~e usllall reasonable diligence and to the best of my knowledge the treasurer has used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best olffy k nowlLl~ge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the fore,Sing is true a~td correct. Executed on At By DATE CiTY AND STATE SIGNATURE OF CANDIDATEIOFFICENO~DER 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 REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES AC~ OF 1977, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLnlcAL REFORM ACT.