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CiTY CLERK 0EPARTt4EN~oVER PA <br /> ...,,*,yen GE-- LONG FORM <br /> Recipient Committee Type or Print in Ink. <br /> Campaign Statement -- Long Form <br /> (Gove~ent C~e S~do~ 842~-~216.5) ~' I~ ~ - ~ - ~ 2 <br /> _ _ <br /> <br /> C~¢k o~ o( I~ lollowl~ bezel to Jndlcal* I~ ly~ of atatement being tiled: Date el <br /> ~ Pre-elation Slateme~ ~ Se~-annual Stale~nt il applicable: <br /> ~ Special ~d*yea; C~aign Re~ (Month, Day, Year) <br /> ~ Suppl~enial P;e-el~tion Stalin (A~ach a c~leied Fo;m 495 Io this siate~nL ) N/~ <br /> ~ Ter~n~i~ Slalemenl (AUach a c~eted Fo~ 4 t5 to this siatemenL } <br /> <br />I Committee Information II Primarily Formed Committee (See definition on reverse.) <br />List names of officeholder(s) or candidate(s) for which this <br />.~.~co~.E~ committee is primarily formed <br />Tnvolvement Makes Political Action <br /> I 830435 <br />Redwood City CA 94063 ( <br />Lawrence K. BuckDaster <br /> <br />Redwood Cif. y CA 94063 ( <br />(Check Boxes) See definition~ and important information on reverse. <br />I$ Ihis a sponsored committee? .................................... [] Yes [] No <br />I$ Ibis a broad based political commitlec? ................... D Yes [] No <br />Attach additional information on appropriately labeled continuation sbeet$. <br />III VerilicaUon <br />I have used all reasoanblc diligence in preparing this sla~emcnt and to thc b~sl of my' knowledge thc information conkaincd herein and in Ibc attached schedules is truc and <br />, complete. I certify under penally of perjury under Ibc laws of thc S~i¢ of California that thc foregoing is truc and c~ecL <br /> <br /> <br />