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Recipient Committee <br />Campaign Statement <br />Cover Page <br />(Government Code Sections 84200-84216.5) <br />SEE INSTRUCTIONS ON REVERSE <br />Type or print In Ink. <br />Statement covers period Date of election if <br />~._ /-p 2,-, (Month, Day, <br />from <br />through /~ -~/~ <br />1. Type of Recipient Committee: ml commtneea -complete Pada t, z, a, ana s. <br />Officeholder, Candidate Controlled Committee ^ Ballot Measure CommiBee <br />Q State Candidate Election Committee QPdmadly Formed <br />Q Recall Q Controlled <br />(Also CompAfe Part S) Q Sponsored <br />^ General Purpose Committee law canpble Pan fit <br />Q Sponsored ^ Pdmadly Formed Candidate/ <br />Q Small Conlnbutor Committee Officeholder Committee <br />Q Political PartylCentral Committee WwCompkla PoU7) <br />3. Committee Information I I.D. NUMBER of ~D~ 7~ <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) 7 7 <br />~- ~j~ <br /> ! r J/lN.'I JI r ~ /~ ~~[ ~O -/\Oel(/ <br />CITY/Y~~OD~ ~~ gTgTE ~~~pE~ AREA CODE/PHONE <br />MAILING ADDRESS (IF DIFFEREN~j NO. AND STREET OR P.O. BO% <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FA% / E-MAIL ADDRESS <br />Dete Stamp <br />it°°~ <br />~t <br />COVER PAGE <br />CALIFORNIA 460 <br />zoovoz <br />FORM <br />JA1V 3 i 2003 <br />CITY C'r hFC:'<..U Clry <br />2. Type of Statement: <br />^ Preelection Statement <br />,~ Semi-annual Statement <br />^ Termination Statement <br />^ Amendment (Explain below) <br />For Official Use Onty <br />^ Quarterly Statement <br />^ Special Odd-Year Report <br />^ Supplemental Preelection <br />Statement -Attach Form 495 <br />Treasurer(s) <br />~~ ~~° 1/ <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX / E-MAIL ADDRESS <br />4. Verification <br />I have used all reasonable diligence in prepadng and reviewing this statement and to the best of my knowledge t e informali contained herein and In the attached schedules is true and complete. I <br />certify under penalty of perjury under the laws of the State of Califomia That the Tor is true and correct. <br />Executed on Ry <br />Sig Wre Tree aialenlTreawrer <br />Executed on By <br />Signabxe irg O6wahaMx, CanGtlale, Stale Meawre Propor~enlor Reegonsible Ofiar of eponsar <br />Ezecuted on n,.. By <br />Executed on By <br />Wle SgnaWreo/Cm4WingOlfx~M1tltler, Candidate,SlakMeawre Pmponenl FPPC Form I6a (June/01) <br />FPPC Toll-Free Helpllne: 666/ASK-FPPC <br />Stale of Califomia <br />N( <br />MAILING ADDRESS <br />