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CITY CLERK DEPARTMENT <br /> RECEIVED <br /> COVER PAGE -- LONG FORM <br />Recipient Committee TYPa or Pdnl In Ink. Slalament covars parled Oalo $1amp <br /> <br />Campaign Statement-- Long Form ~ Z~ I 21 ~ '~ <br />(Government C~c S~o~ 842~-~216.5) lrom ] - ~ - ~ ~ <br /> <br />~E I~T~T{~ ON RE~R~ Ihro~h ~ - ~ O - ~ ~ Paga ] of <br /> <br />~ Ple*el~lionSlalemenl ~ Sem~-annualSiatemeni Ilappllcable: <br />~ Special~d-yea~ Campaign Repo~ IMonlh, Day, Yearl <br /> <br />~ Sup~ental Pm-el~lion Stal~nt (AIlach a c~leted Fo~m 495 ~o Ih~s slale~nl ) N/~ <br />~ Te~minatio~ Slale~nt (Atlach a c~eled Form 415 to Ibis s;alemenl ) <br /> <br />I Committee Information II Primarily Formed Committee (See definition on reverse.) <br />List names o! officeholder(s) or candidate(s) for which this <br />,~C~CO~,T[[: committee is primarily Iormed <br /> <br /> Involvement Makes Political Action Work ~.~c~e^,Ets)o.~t,m,~m,~s) m,cEso~.,,~,,~m c,*c~ <br /> Broadway{ 8~0435 <br /> Redwood City CA 9~ 1772 <br /> Lawrence <br /> Broadway <br /> Redwood City CA 1772 <br /> (C~ct Bo~s) See definition~ and i~rtant in fore,ion on reverse. <br /> Is~i~as~n~r~commit~? .................................... D Yes ~ No <br /> la ~is a bm~ ~ ~li6~l ~mitl~? ................... D Yes ~ No <br /> <br /> Attach additio~l i~or~tion on appropri~ely ~bel~ co~i~ati~ s~eett. <br /> Ill VerillGalion <br /> I have u~d all rc~nablc diligcn~ in prepping ~is sm~menl ~d Io thc ~sl of my' k~wl~gc ~c inflation c~mincd herein and in ~c all~h~ schedules is ~ and <br /> complex. I ~flify under ~lly of ~rju~ und~ ~e laws of ~c Sm~c of Califo~ia Ihat Ihe f~egoing is ~uc a~l. / <br /> <br /> <br />