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COVER PAGE - LONG FORM Officeholder, Candidate co~-~ ~e~,O~ Date Stamp and Controlled Committee Ol/01/ Campaign Statement - Long Form (Government Code Sections 84200 - 84216.5) through 0 6 / 3 0 / ~ __ of 6 [] Pre-election Statement Date of Election JUL 3 I ~ A For Official Use Only [] Supplemental Pre-election Statement (Attach a completed Form 495 to this statement.) if applicable: [] Special Odd-Year Campaign Report (Month, Day, Year) ' 01: [] Semi-annual Statement [] Termination Statement (Attach a completed Form 415 to this statement.) I Officeholder, Candidate, and Controlled Committee II Other Committees Not Included in this Statement: Included in this Statement List any other committees not included in this consolidated statement that are controlled NAME OF OFFICHOLDER OR CANDIDATE: by you and any committees of which you have knowledge that are primarily formed to Matt Leipzig receive 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 RESIDENTIAL OR BUSINESS ADDRESS: (NO. AND STREET) 580 E1 Camino Real NAMEOFTREASURER: CONTROLLEDCOMMITrEE? CITY STATE ZIP CODE AREA CODF. fDAY~ME PHONE [] YES [] NO San Carlos CA 94070 (415) 593-5888 COMMITrEEADDRESS: (NO. ANDSTREET) COMMITTEE NAME: I.D. NUMBER Friends of Matt Leipzig cr~Y STATE ZIPCODE AREACODE/DAYTIMEPHONt= 951036 COMMI'I-rEE ADDRESS: (NO. AND STREET) COMMI'I-rEE NAME: ~ I.D. NUMBER 580 E1 Camino Real I CiTY STATE ZIP CODE AREA CODE/DAYTIME PHONE San Carlos CA 94070 (415) 562-3565 NAMEOFTREASURER: CONTROLLED COMMITTEE? NAME OFTREASURER: [] YES [] NO Larry Aikins COMMI3-rEE ADDRESS: (NO. AND STREET) PERMANENT ADDRESS OF TREASURER: (NO. AND STREET) 926 Woodside Road CITY STATE ZIPCODE AREACODE/DAYTIMEPHON[- CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE Redwood City CA 94061 (415) 369-7331 Ill 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 complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on At By DATE CITY AND STATE SIGNATURE OF TREASURER I have used all 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 of my knowledge 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 foregoing is tree and correct. Executed on At By DATE CITY AND STATE SIGNATURE OF CANDIDATE/OFFICEHOLDER Executed on At By DATE CITY AND STATE SIGNATURE OF CANDIDATE/OFFICEHOLDER Executed on At By DATE CITY AND STATE SIGNATURE OF CANDIDATE/OFFICEHOLDER S/CCW - PCAP02970457 (Rev. 3/94) State of California Fair Political Practices Commission.