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. __~ LONG FOR M Officeholder, Candidate, Tm- or Print In Ink. cover~ period Dale $iamp and Controlled Committee 'l/'l/9 Campaign Statement -- Long Form from (OovcnunCmsEE INSTRUCTIONsC°dc SccdmsON84200-842REVERSEI6.5) throug 6 / 3 0 / 9 1 Check one of the following boxes to indicate the type of statement being filed, Date of Election i' ~--- .., ~--~ A For Oiii¢ial Us. Only [] Pre-election Statement if applicable: [] Supplemenlal Pre-election Statement (Attach a completed Form 495 to this slatemenl.) (Month, Day, Year) [] Semi-annual Statement [] Termination Slalement (Altach a completed Form 415 Io this statement.) I Officeholder, Candidate, II Other Committees Not Included in this Statement: List cay other and Controlled Committee committees not included in this consolidated statement that are controlled by you and Included in this Statement committees of which you have knowledge that are primarily formed to receive contributions or NAME OF OFFICrd4oLDER OR CANDIDATE: tO mak~ e~oenditur es on behalf of your candidacy. GEORGI LA BERGE COMMITTEE NAME: I D NUMSER OFFICE SOUGHT O~ HELD: (INCLUDE LOCATION AND OISTRICT NUMI~ER IF APPLICABLE) MEMBER, CITY COUNCIL REa[:~NTIAL OR ~MESS ADORE~: (NO A/dO STREET) ~ ~ TREASL~ER: CCX',IIROLLED COMMITTEE? 1637 Carleton Court (415) 574-6231 ~]¥ES [~NO CITY STATE ZIP COl~i AREA COCEJOAYTIME PH, O~E COklMITTEE ,AEN~ESS: (NO. AND STREET) Redwood City CA 94061 C(~dMITTEE NAIME: lO NUMBER CITY STATE ZIP (~3OE AREA CO~ciD~YTIME PHONE CITIZENS TO RE-ELECT GEORGI LA BERGE 851670 CCMMITTEE NAME: I O NUMBER COM~TTEE ADE~IESS: (NO. AND STREET) 1637 Carleton Court CITY STATE ZIP CO(~ AREA COOF. JI~YTIME Pt~NE NAME OF TREASURER: CONTROLLED COMMITTEE? Redwood City, CA 94061 (415) 574-6231 i--lYES I-~NO NAME OF TREASURER: COMMITTEE ADORESS: (NO. ANO STREET ) ; Georgi La Berge PERMANENT AL)ORESS OF TREASURER: (NQ ANO STREET) CITY STATE ZIP COOE ARE. A COOE./E]AYTIME PHONE i 1637 Carleton Court CITY STATE Zl~ C(X~ AREA CO(:~JORYTIME PH(NdIE ~ Attach additional information on appropriately labeled continuation sheets. Redwood City CA 94061 (415) 574-6231 III Verification Officeholder or Candidate: Treasurer: I have used ali reasonable diligence and to thc best of m~knowledgc thc ucasurer has I have used ali reasonable diligence in preparing this statement and to thc best of my used all reasonable diligence in preparing Ihis slatcmcnt. I have reviewed thc slate- knowledge thc information contained herein and in the auached schedules is Iruc and ment and to the best of my knowledge Ihe information contained herein and in the complete. ! cerdfy under penalty of perjury under the laws of the Slate of California attached schedules is uuc and complete. I certify under penalty of perjury under the , that thc foregoing is Iruc and correct, laws of thc State of California that thc fox--and correct. SIGNATURE OF ~L~RER ' . (J SIGNATURE OF OFFICE~LDER OR CANDIDATE FOR INFORMATION REQUIRED TO BE PROVIDED TO ?OU PURSUANT 1'O IHE INFORMATION PRACTICES AC T OF 1971, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLID~/~.. REFORM/LC.L[ Slate of Calilomla Fair Political Praclices Commission.