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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 />Date of election if appl <br />(Month, Day, Year) <br />Date Stamp <br />r, <br />L L ll r <br />COVER PAGE <br />JAN 2 1 2004 i~J~~ Page of ' _ <br />Statement covers period <br />from 6r-o/-o3 <br />through ~~ _ ~/~D~ <br />Type of Recipient Committee: All committees -complete Parts f, s, a, and 4. <br />Officeholder, Candidate Controlled Committee ^ Ballot Measure Committee <br />Q State Candidate Election Committee Q Primarily Formed <br />Q Recall ~ Controlled <br />(asoco<rrplerePade/ 0 Sponsored <br /> <br />^ General Purpose Committee (Also Complete Part 6) <br />Q Sponsored ^ Pdmadly Formed Candidate/ <br />Q Small Contributor Committee Officeholder Committee <br />Q Political Party/Central Committee (Also Complete Part 7) <br />3. Committee Information I I.D. NUMBER <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br />~e-~l~~-~ ~ ~ ~ <br />WOoG~ ~ <br />~-~.rfi,t~f <br />IxC~ Y"/ <br />STATE ZIP COD <br />~''~D(~3 <br />TREET OR P.O. BOX <br />N ~ I For Official Use Only <br />CITY OF R~D'J'/COD CITY <br />CITY C! cRK <br />2. Type of Statement: <br />^ Preelection Statement ^ Quarterly Statement <br />Semi-annual Statement ^ Special Odd-Year Report <br />^ Termination Statement ^ Supplemental Preelection <br />^ Amendment (Explain below) Statement -Attach Form 495 <br />~, Treasurer(s) <br />NA OF TREASURER <br />Ennis Rd ~~ <br />x(' MAILG~y DRE~~ J ~ ,.//~~t~ ~ ~ ~ ~t~ ~~~ /~~ <br />V ,aS~o CITYY ~////• l ~~DD1 c~ // r/,` /A Y•, ~A~.. ~t~('~~~'' <br />CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY <br />N / A- <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX / E-MAIL ADDRESS <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 preparing and reviewing this statement and to the best of my knowledge the ' forma n contained herein and in the attached schedules is lme and complete. I <br />certify under penalty of pery'ury under the laws of the State of Califomia that the fo er going is true and correct <br />~ ~. <br />Executed on By <br />Da Signature ofTreesure rAssistant reasurer <br />Executed on ~ By <br />Da Signature hdtler, Cantlitlare, Stare Measure Proponent or Responside Officer ofeponsor <br />Executed on By <br />Dale Signature of ConVdBng Officeholder, Canditlate, Slate Measure Proponent <br />Executed on By FPPC Form 460 June/01 <br />Date $gnelure o(Contrdlirg ORceholder, Candidate, Stale Measure Proponent ( ) <br />FPPC Toll-Free Helpline: 8661ASK-FPPC <br />State of California <br />