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OffiCe. holder, Candidate, COVER PAGE LONG FORM <br />~JndControlled Committee Type orprintin ink. Stat,m, v.rsper,od Oa,eS,... C*"FO""'^ 490 <br />Campaign Statement- Long Form from >~'/~TiY 94 FORM <br />(Government Code Sections 84200-84216.5) i' h ~, <br />SEE )NSTRUCTIONS ON REVERSE througl " ~' : ~:' ~ of <br />Check one of the following boxes to indicate the ~pe of statement being filed: Date of election if applicable: For Official Use Only <br />~ Pre-eleclion Statement (Mon~. Day. Year) ~U~ 2 ~ <br />~ Supplemental Pre-electi~ Statement (Attach a complel~ F~m 495 to this statement.) <br />~ Special Odd-Year Campaign Re~d <br /> <br />~ Termination Statement (Attach a ~mplet~ F~ 415 to this statement.) GtTY GLEP~ <br />I Officeholder, Candidate, and Controlled Commiffee II Other Commiffees Not Included in this Statement: <br />Included in this Statement commi~es not includ~ in ~is consolidated statement that a~ ~n~ged by you and <br /> <br /> ~ 0 ~ ~ ~ 3 0 ~ A ~ ~n~b~ns or~ make ex~nditu~s on ~half of your ~ndidacy. <br /> COMMITTEE NAME I.D. NUMBER <br /> OFFICE SOUGHT OR HELD (INCLUDE L~ATION AND DISTRICT NUMBER tF APPLICABLE) <br /> <br /> RESIDENTIAL OR ~USINESS A~RES~ (NO. AND STREET) / NAME OF TREASURER CONTROLLEO COMMITTEE? <br /> <br /> CITY STATE COMMITTEE AODRESS (NO AND STREET) <br /> ZiP COE / ARE CODE/DAYTIME PHONE <br /> <br /> COMMITTEE NAME I.D. NUMBER CITY STATE ZIP CODE AREA CODE~AYTIM E PHONE <br /> COMMITTEE ADDRESS(NO AND STREET) <br /> , NAME OF TREASURER <br /> <br /> NAME OF TREASURER <br /> ~e~z~e~ ~ CITY STALE ZIP CODE AREA CODE/DAYTIME PHONE <br /> PERM~ENT ADDR S~ OF TREASURER <br /> <br />III Verification <br /> <br /> complete, I cedi~ u~er penalty~f ~rju~ under ~e la~ of the S~te of Cali~nia ~t ~e for~i~ is Irue ~c~re~t.~ _ ~ _ _ ~ <br /> <br /> DATE CI~ ~O STA~ ' ' 7/ ~ 0 U SIG~TURE OF TREASURER <br /> <br /> An officeholder or candidate who controls a commiffee must also ve~ the ~mpaign statemenfl hav~ ~ all reasombl~diligence ~ lo t~ ~st of my k~edge the lreasurer has used all <br /> reasonable diligence in preparing this statement. I have review~ the stal~ent a~ 1o ~e ~st of my k~wle~ t~ info~ati~tai~ ~- *~v ~.=c~c~ c:hedules is ~e a~ ~plete. <br /> under penalty of ~rN~ ~nder the laws of the State of Calif~nia that Ibc f~e~ng is true and ~rr~l. <br /> <br /> Execuled on. At By <br /> Execuled ~ At By <br /> State of California Fair Political Practices Commission <br /> <br /> <br />