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Of fig Iolaer, bailUlUUl~, COVER PAGE - LONG FORM and Controlled Committee Type or print In Ink. Statement covers period Date Stamp Campaign Statement- Long Form ,~o~ ~/~ (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE through ~/~ ~ ~ / / ~ Page - of ~ Check one of the following boxes to indicate the type of statement being flied: Date of election g applicable: For Official Use Only ~ Pre-election Slalement (Month, Day, Year) ~ Supplemenlal Pre-eleclion Slalement (A~ach a completed Form 495 to this statement.) ~ Special Odd-Year Campaign Repod ~ Semi-annual Statement //~ ~ ~ ¢~ ~ Termination Slalement (Aflach a completed Form 415 to this statement.) I Officeholder, ~andidate and Controlled Committee II Other Committees Not Included in this Statement:Llst any other IncludedIn this Statement commi~s not Included In this consolidated statement that a~ controlled by you and NAME OF OFFICEHOLDER OR CANDIDATE any committees of which you have knowledge that are primarily formed to receive COMMITTEE NAME I.O. NUMBER RESIDENTIAL OR BUSINESS ADDRESS (NO. AND3TR[EI) NAME OF TREASURER CONTROLLED COMMITIEE? COMMITTEE NAME I.D. NUMBER CITY STATE ZIP CODE AREA COOEIOAYTIME PHONE COMMITTEE ADDRESS{~. AND STREEI) I.D. NUMBER NAME OF TREASURER ¢¢~ ~ CITY STATE ZIP CODE AREA CODE/OAYT,ME PHONE CITY ~>~ e~ gfE ?¢~ ¢~D~: ~ Attachaddgionali, for~ationonapp~p~atelylaboledcogti, oago, shoots. III Verification I have used all reasonable diligence in preparing lhis slatement. I have reviewed the statement and 1o the best of my knowledge the information contained herein and in Ihe a~ached schedules is true and complete. I cedlly under penal~ ofperjuw under lhe laws¢lhe Slale of Calilomla that the Iomgoing is true and correcl. DAlE CI~ ANd STACE ' SIGNATURE OF TREASURER An officeholder or candidate who controls a commilta~ must also verify the campaign statement. I have used all reasonable diligence and lo the best ct my knowledge the Ireasurer has used all reasonable diligence in preparing Ihis stalement. I have reviewed lhe slatemenl and to lhe besl of my knowledge the information conlained herein and in lhe attached schedules is flue and complele. I cedify under penalty of perjuW under Ihe laws ol the Stale ol California lhal the foregoing is flue and correcl. Executed on Al By Execuled on At By State of California Fair Pollllcal Practices Commission