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CITY ~LERK 0EPART~£~T COVER PAGE-- LONG FORM <br />Recipient Committee Typa or Print In Inks Statemant covers period <br />Campaign Statement -- Long Farm <br />(Oovemmem Code Sections 84200-g42 ] 6.5) from <br />~ P~g~ of. <br />0 Pre-elation Statement O Semi-annual Statemenl Il applicable: <br />~ Special Odd-year Campaign Repod I~onl~, ~l, Y~rl <br />O Suppl~enlal Pm-el~lion Slalement (A.ach a compleled Form 495 Io this slale~nL ) <br />~ Terminalion 8talemenl (A~ach a compleled Form 415 Io Ihis slalemenl.) <br />I Commillee Inlor~alion II Primarily Formal Com~llee ISee delinilion on reverse,) <br />Lilt nates ol ofliceholderlsl or ca.did.tels) lot which lhis <br />~ ~C~TT[[: co--lille Is primrlly Iormed <br /> <br />~nvolvemen~ Mskes Politic81 Action Coun~ ~C~OA~IS~As) ~S~HT~ <br /> oadway~ 83043~ <br />Red~ood City CA 5) <br />La~:ence Buck~st~ <br /> ay <br />Red~ood City CA 940~ ~7Z2 <br />( C~ck Bo~s) ~ge gg~ni~io~ and imporldnl in~or~lion on <br />Is ~is a s~nmr~ commil~? .................................... O Yes ~ No <br />is ~is a broad ba~ ~li[i~l ~mmi.~? ................... ~ Yes ~ No <br /> <br /> AYtach additio~l infor~ion on appropri~ely ~bel~ co~i~ati~ she~s. <br />Ill ga~ili~atlon <br /> <br /> I have u~d all re~nable diligence in preparing this sm~ment ~d to the ~st of m~ knowl~ge the info~ation contained herein and in ~e at~ch~ schedul~ is ~e and <br /> compleX. I ~fy under ~lty of ~rju~ under ~e laws of ~e S~te of California that Ihe foregoing is ~ co~t. <br /> Executed on At, By. <br /> F~ IN~ATI~ REQUIRED TO BE ~OVIDEO ~O Y~ ~SUANT TO T~ INF~MAT~ P~CTICES ~T ~ 1977, SEE INFORMATI~ MANI I~ ~-CAMPAiGN ~1~1 ~HRE ~VISI~S ~ ~E ~ IT~AI REF~M A~T <br /> Slate of California Fal~ Pollllcal Practlcea Comml=slon. <br /> <br /> <br />