CpnStmt Leipzig, M 951036 - Laserfiche WebLink

Browse Search

men d. me n..t. to. .... Type or print in ink Date St--~ AMENDMENT T~is form must b~ used to amend statemen~ fil~d pursuant to Government Code Seaions 81200-84216 5 anti must be f ed w th a filing off?.~rs who received th~ statement being amended. NOTE: Do not us~ t~is form to amend a Statement of Organizat on, Form ~: ~ ..... ~ } ~[~ ~ ~ ' al0, C~no.oatelntent~on,~orm 501,oraCampeignBankAcceunt,~orm 502. Usetheaaua ~orm ~10,501 or502 res~avev tomak~ amendments. ' -' The information required in Pa~ I must corres~nd to the information provided on the campaign statement ~ing amended, j I Name of Filer ae~ ~o..~,i.~o~m.ti~ ~,~.~ ~ II Amendment Info~~ NAME OF FILER ] I.D. NUMBER A. The following information amends campaign disclosure ' A~I~E) statement, Form No. I MAILING ADDRESS OF FILER (NO. AND STREET) executed on. for the peri~ through (MO, DAY, YR.) (MO, DAY, YR.) (MO, DAY, YR.) CITY STATE ZIP CODE B. The amended information affects items on the: *REACODE~AYTIME PHONE NUMBER ~ CoverPa~ [~ AIl~ationPage ~ Summary Page ~ Schedule(s) ~ Pa~s) NAME OF TREASURER IF RECIPIENT COMMITTEE C. Describe the changes below. Include in detail all information you wish to become a pa~ of yocr official campaign statement. Please a~ach a cover PERMANENT ADDRESS OF TREASURER: (IF'APPLICABLE) (NO. AND STREET) Pa~, summary pag~ and/or appropriate schedule(s) to this Form 405 if n~cessary for clarification. Include additional information on appropri- ately labeled continuation sheets. (Number of sheets a~ached .) ClT~ , STATE ZIP CODE AREA CODE~AYTIME PHONE NUMBER III Verification fsee imoo,~ant information on rever~.) 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 cert~y un~/~ penalty of perjury under the laws of the State of California that the foregoing issue and correct. CITY AND STAI~ - SIGNATURE OF TREASURER OR FILER Officeholder, candidate, state measure proponent, or sponsored committee responsible officer verification: I have used all reasonabk: 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 is true and complete. I certify under penalty of perjury under the laws of the State of CaMornia that the foregoing is true and correct. Executed on At By DATE CITY AND STATE SIGNATURE OF OFFICEHOLDER, CANDIDATE, PROPONENT, OR RESPONSIBLE OFFICER Executed on At By DATE CITY AND STATE SII;NATURE OF OFFICEHOLDER, CANDIDATE. OR PROPONENT Executed on At By DATE CITY AND STATE SIGNATURE OF OFFICEHOLDER, CANDIDATE, OR PROPONENT FOR INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE I~!FORMATION PR.a. CTICES ACT OF 1977, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLITICAL REFORM ACT State of California Fair Political Practices Commission