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Type or print in ink. COVER PAGE - PART 2 <br />Recipient Committee <br />Campaign Statement <br />Cover Page m Part 2 <br /> Page__ of__ <br /> <br />4. Officeholder or Candidate Controlled Committee 5. Ballot Measure Committee <br />NASC E EHO O;C D,;A2 .AMEOFEA"O'MEASURE <br /> <br /> OFF~E SOUGHT OR HELD (INCLUDE~ LOCATION AND DISTRICT NUMBER IF APPLICAB~LI[i) BALLOT NO. OR LE~rER JURISDICTION [] SUPPORT <br /> <br /> RESIDENTIAL/BUSlNESSADDRESS (N~.ANDSTREET) I CITY STATE ZIP identlfythe controlllngofflceholder, candldate, orstatemeasureproponent, ifany. <br /> [.('~\ ~'-~ '~ ¢. ICe ~DoC~ C~'~/ ~ q 40 ~ / NAMEOFOFF,CEHOLDER, CAND'DATEOR, PROPO"EN' <br /> ¥ <br /> Related Committees Not Included in this Statement: [istanycornmittees <br /> <br /> COMMITTEENAME OF TREASURERNAME I.D.coNTROLLED[]NUMBERYES COMMFFTEE?[] NO 6.NAME forwhichthi$commi#eeisprirnarilyformed.PrimarilYoE OmCEHOU~ERFormedoR c^ND~DA?EC°mmittee OF~CEU't n,~,e~SOUG~Of o~,o~,~'~)O~ HELB ~'[][]=andid't~'~O.POsEsu~PO~ <br /> NAME OF OFFICEHOLDER OR CANDIOATE OFFICE SOUGHT OR HELD [] SUPPORT <br /> COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) [] OPPOSE <br /> <br /> CiTY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [] SUPPORT <br /> [] OPPOSE <br /> <br />7. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules <br /> is true and complete. I certify under penalty of perjury under the laws of the State of California t~at the foregoing is true and correct. <br /> <br /> --1 ~l oo <br /> <br /> SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR <br /> <br /> Executed on By <br /> DATE SIGNATUt~ E OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT <br /> <br /> Executed on By <br /> DATE SIGNATURE O F CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASU RE PROPONENT <br /> <br /> FPPC Form 460 (8~9) <br /> For Technical Assistance: 916/322-5660 <br /> State of California <br /> <br /> <br />