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Reciaient Committee Type OFpHntinlnk. COVER PAGE - LONG FORM <br />Statement covers perlod Date Stamp <br />Campaign Statement -- Long Form <br />(~ove,nment Co~,Se~ons 84200-842~6.S) f,om ~/~ <br />~eckoneofthefollowlng~xeltolndlcatethe~ofstatement~ngflled:Da{eofele~lonffappllcable: }~E.~ 2 - 1996 <br />(Month, Day. Year) ~ <br />~ Pre-ele~ionStatement ~ Semi-annua{Statement <br />~ S~cialOdd-yeerCampaignRe~ CiTY 0F <br />~ Supplemental Pre~te~ion $tatemekt (A~ach a corn plated Form 49S to thi~ Statement.) CITY C L E R K <br />~ Termination Statement (A~ch a corn plated Form 41S to thi~ ~atement.) <br />r <br />I <br />Committee <br />Information; <br />II <br />~rimarily Formed ~ommittee (See definition on reverse,) <br />Li~t nam~ of o~i~eholder{~} or ~ndidate{~} for which <br />NAME OF <br />this committee is primaril~ formed. · <br />NAME OF TRE~URER <br />_ Is this a broad based political commi~ee? ......... ~ Yes ~ No Attach additional info. etlon on app~prietely la.led continuation shee~. <br />III Verification -. <br />I have used all reasonable d~li~ence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained <br />herein and in the a~ached ~hedules is true and complete. I ce~i~ under penalty of perjury under t~e laws of the State of California that the foregoing is true <br />and corre~. <br />. Executed on At By <br /> <br /> FOR INFORMATION REOUr~L[O TO SE PROV~O[ O TO YOU PUP, SUANT '~O THE :NFO~=,MATiON PR.~CTrC[$ ACT OF 1977. SEE INFOaMATION MANUAL ON CAMPAIGN Dr$CLOSURE PROVISIONS OF THE POLmC~L R [ ~ OF',M ACT. <br /> <br /> State of CallfoFnla Fair Political Practices Commission <br /> <br /> <br />