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LONG FORM Officeholder, Candidate, Type or Print In Ink. Statement covers p®dod Dale Slamp and Controlled Committee Campaign Statement--Long Form. [~ ~ ~ ~ ~ (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE e Chock one o! tho following boxes to indicate the type of statement being filed: Date of Election A For Ollicial Use Only [] Pro-olOctio~ Statement if applicable: JAN 3 I 199 [] S~pplemenlal Pm-elactic~ Slatemenl (Atlach a compleled Form 495 Io Ibis slalement.) (Month, Day, Year) ~'Semi-annual Statement [] Terminalion Stal~nent (Attach a completed Form 415 to Ibis slat~ment) I Officeholder, Candidate, II Other Committees Not Included in this Statement: List any other and Controlled Committee committees not included in this consolidated statement that are controlled by you and any Included in this Statement committees of which you have knowledge that are primarily formed to receive contributions or md~ CF CFFK~HOCn~ OR c_,an~m, TE: to make expenditures on behalf o/your candidacy. CFFICE Souom Ofl.~LD: (INCL~LOC- I~i ) RESII3ENTIAL OR ~dSINESS A/DORESS: (NO A~JDSTREET-) - ' NAME CF TREASURER: CONIROLLEO COMMITTEE? CiTY ' STATE ZIP CODE AREA CO(~E/I~AYTIME PHO~I: COMMITTEE ADORE,SS: (NO. AND SIR£EI') COIdMfl'TEE NAME: I I ID. NLIMB~R CiTY STATE ZIP COOE AREA COE~'c./OAY11ME PHC~Ib I ·. n /8 ~)""'1 b 7~,,~ COMMITTEE NAME: IONUMB£R COMMfn'EE ADORES,q: (NO. ANO STREE1) CiTY STATE ZiP CO{~ AREA COCEA]AYTIME PHONe NAME CF TREASURER: COHIROLLED COMMIHEE? NAME CF TREASURER: I COMMIHEE ADORESS: (NO. ANO STREE[ ) PERMANENT ~ CF TREASURER: (NO. ANO~T,~EE~) CiTY STATE ZiP COOE AREA CO(3EJDAY~iME PHONE CflY STAI'E ZiP CO(~ AREA ~YTIME ~ ~Q~ ~ 0 0 6 C(f'~ / ~ '~ ~[ g~ ~ I /_~[ b'~,) ..¢.'~ g- ~,,~.~ / Attach additional information on appropriately labeled continuation sheets. III Verification Officeholder or Candkl-te: Tren,ur~: I have used aU reasonable diligence and to the best of m~knowledge ~he a'easurer has I have used all reasonable diligence in preparing this statement and to ~be best of my used all reasonable diligence La preparing this statement. I have reviewed the state- knowledge ,he information contained herein and in the auached schedules is true and merit and to the besl of my knowledge the information comained herein and in the complete. I certify under penalty of perjury under me laws of the State of California attached schedules is ~rne and complete. I certify under penalty of perjury under the that thc foregoing is u~c and correcL laws of the State of California that the foregoing is true and correct. CII~'AND STATE~5 ClIY ANO STA~E SlGNATURI~c TREASURE n (~ SIGNATURE O¢ OFFICEHO~R OR CANDIDATE FOR INFORMATION REQUIRED [O BE PROVIDED TO YOU PURSUAN1 [O THE INFORMATION PRACTICES ACT OF 1977. SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE I?OLIllCAL REFORM Stato of California Fair Political Practices Commission.