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Amendment to AMENDMENT Campaign Disclosure Statement *ypeorpr~ntin~nk Thi~f~rmmust~usedt~amend~atemen~fi~edpur~uantt~G~vernmentC~e~e~i~n~842~-84216~5~and must ~ filed with all [~ ~'~ ~ :~ ' ' ~or Official Use Only fd ng office~whorece~vedthe~atement ~mgamended. NOTE: Donot usethisformtoamendaStatement ofOrganization, Form 410. Candidate lntention, Form SOl.oraCampaign~nkAccount, Form S02. Uset~e a~ual Form 410,50~ or 502, res~ively, to make ~ o It~n required in Pa~ I mu~ corres~nd to the information provided on the ~mpalgn statement ~ing amendS. I Name of Fder (~eim~antlnformati~.) II Amendment Inform~ .AM; OF F~t;. I ~'~' ~UM~t~ A. The following informatio~ ~mends rampaign di~d~ure ~~ ~O~ ~A~E, statement, Form No. ~ , CITY ~ / ~O ~ O00 ~/~ ~ / STATE ZIP CODE a. The amended information affects items on the: AREACOD~AY~MEPHONE~UMBER ~. ~A ~ D EoverPage ~ AIl~tlonP., D Summa, Pa, ~F~ ~ become a pan of your official campaign statement. Please a,ach a cover PERMANENT ADDRESS OF TRE~URER: (IF APPLI~BLE) (NO. AND STREET) page. summa~ page and/or appropriate schedule(s) to this Form 405 if ~ ~ ~~~ ~ n~lry for {l~rifi~fion. Indude ~ddition, I information on AREA CODE~AYTIME PHONE NUMBER/ III Verification ($eeimDortantinformationonreverse.) I have used ell reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is t~ Officeholder, candidate, state measure proponent, or sponsored committee responsible officer verification: I have tTsed all reasonable diligence and to the best of my knowledge the treasurer has used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knqw~edee the ipforma~ion contained herein is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. [ ~ E CITY AND STATE/ ~ SI~JATU~OFOFF~CEHOLDER. CANDIDATE.PROPONENT, ORP~$PONSlBLI~OFFiCER Executed on At By Executed on At By DArE DrY AND STAT~ ~IGNATURE or OFFICEHOLDER, C&,NDIDA T S, OR PROPONENT FOR iNr ORM&¥1ON R[OUIRED 1[0 ~1[ PROVIDE D TO YOU PUR~UANr TO THE IN~ O,~MATroN PRACTI(£~ ACT OF 1~77, ~E[ INFORMArION MANUAL ON CAMPAIGN DISCLOSURe[ PROVISIONS OF TH~ POLI'~ICA[ R~-ORM ACT State of California Fair Political Practices Commission