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Off~eh61der, Candidate, <br /> COVER PAGE - LONG FORk <br /> aff¢ C0fitrolled Committee Type or print in ink. Stateme.nt.c~).ver,S ~e_riod Date Stamp <br /> CAUFORNI,A: <br /> Campaign Statement - Long Form from ---- ~ 19~ FORM~ <br /> (Government Code Sections 84200-84216.5) /[d/~ ~ ~;~ ;~ ' .... <br /> <br /> SEE IN~TR~TIONS ON REVERSE through /~/////~ [~ i&~ :'~[k l.~l <br /> Check one of the following boxes to indicate the ~pe of statement being filed: ~ "< <br /> ~e~leca~ S~tement Date of election if applicable: ~.; ~ <br /> <br /> ~ Supplemental Pre-election Statement (Aaach a completed Form 495 to ~is statement.) (Month, Day, Year) ~ ~ 0C~ 2 2 ~ <br /> ~ Semi-annual S~tement CiTY OF ~m~, ~ <br /> ~ Te~ination Statement (A~ach a completed Form 415 to this statemenl.) C~TY CLERK <br /> I Officeholder, Candidate, and Controlled CommiEee II Other Commiffiees Not Included in this Statement: <br /> Included in this Statement <br /> commie, s not included in this consolidated statement that a~ con.oiled by you and <br /> NAM OF OFFICEHOLDER OR CANDIDATE <br /> ~1~ ~ ~ any commi..s of which you have knowledge that are primarily formed to receive <br /> contributions or to make expenditures on behalf of your ~ndidacy. <br /> OFFICE SOUGHT OR HELD {INCLUO L~ATION AND DISTRrCT NUMBER IF APPLICABLE) COMMI~EE NAME I.D. NUMBER <br /> <br /> COMMITTEE, :~~NAM~ ~ ~*~~ '.D.:~S~:"UMBER COMMITTEENAMECITY STATE ZiP CODE AREA COD~DAY'IME PHON~ <br /> I <br /> <br /> PERMANENT AODRESS O~ TREASURER {NO. ANO STREET) CITY STATff ZiP CODE AREA CODE/DAYTIME PHONE <br /> <br /> CITY ~~a e/W S~ ZI?O~.T~jE;~r~ Attachadditio,ali, fo~atio, onappropdate, labelodco~tinoatio, sheets. <br /> <br />III Verification <br /> I have used all reasonable diligence in preparing th~s slatemenL I have reviewed lhe statement and to lhe best of my knowl~ge the information conlained herein and in the a~ached schedules is true and <br /> complete. I ce~ify un~r penal~ ol pe~u~ under the laws of the State of Calif~nia that the foregoing is true an~ct. _ ~ _ <br /> <br /> reasonable diligence in preparing this statement. I have reviewed lhe slalement and to lha bes o my knowledge t~d <br /> under penally ol perju~ unde~e laws of the Stale of California Ihal the toreaoing is Irue and correct. ~ herein and in the allached schedules is true and complete. I c~aify <br /> S~G~ATURE OW <br /> Executed on At By <br /> Executed on At By <br /> <br /> State of California Fair Potitical Practices Commission <br /> <br /> <br />