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CITY CLERK <br />RECE[¥ED <br />Recipient Committee Typeor prlnt iD Ink. COVER PAGE - LONG FORM <br />Campaign Statement -- Long Form Statement~overs~r~ [ DateStamp <br />(GovernmentC~eSe.ion, S,200-84216.5) from ~-1-94 ] L 3Z tO <br />~k ~ ~ the follo~ng ~xes to Indi~te the ~ ~.atement ~ing filed: Date ~ el~n ff appllcaMe: . <br />~ S~cial~d-yearCam~ignRe~l~~- <br />~ Supplemen~l Pre~l~ion Statement (A~ach a completed Form 49S to this Statement.) <br />D Termination Statement (A~ach a completed ~rm 415 to this ~atement.) CI~ CLER~ <br />Primarily Formed Commiffee (See definition on reverse.) <br />I Commi~eeNAME OF COMMl~EEInf°rmati°n~ II ~ist names of o~iceholdeKs) or candidate(s) for which <br />this commiffee ~s primarily formed. <br />[nvolvemen[ Ha~es Poli[~ca[ Action <br />~SS ~ C~M~EE ~. AND STKEE~ I I,D, N~SER S~ <br /> 830435 <br />Redwood C~t~ C~ 94063 ( <br />Lawrence Buckmaster <br /> <br />Redwood City CA 94063 ( <br />i <br />III Verification <br /> I haw~ used all reasonabl~ dili~n~ in pr~parin~ this statement. I ha~ r~wi~w~d th~ statement and ~ :h~ best of my knowl~d~ lh~ information contain~ <br /> h~r~m~ndmth~a~ach~d~h~ul~s~slm~and~om I~t~ I~e~ und~ ~nalt of ~Ku und~rth awsofthmStat ' <br /> ano corr.. . / / <br /> Ex~uted On At By <br /> DATE ~Y AND STATE S~TU~ ~ .ES~SIBL~ <br /> <br /> <br />