Laserfiche WebLink
COVER PAGE <br />Recipient Committee Type or print in ink. Date Stamp <br />Campaign Statement <br />(Government Code Sections 84200-84216.5) ~ ~ ~[~[~ <br /> Stateme? cove? period Date of election if applicable: Page <br /> ~"/! / ~-,~0 (Month, Day, Year) JAN 3 I ZOO1 <br /> For Official Use Only <br /> from <br /> <br />1. Type of Recipient Committee: All Committees- Complete Parts 1, 2, 3, and 7. 2. Type of Statement: <br /> ~Officeholder, Candidate [] Primarily Formed Candidate/ [] Pre-election Statement [] Quarterly Statement <br /> Controlled Committee Officeholder Committee [~Semi-annual Statement [] Special Odd-Year Report <br /> (Also Complete Part 4.) (Also Complete Part 6.) [] Termination Statement [] Supplemental Pre-election <br /> [] Ballot Measure Committee [] General Purpose Committee [] Amendment (Explain below) Statement- Attach Form 495 <br /> O Primarily Formed O Sponsored <br /> O Controlled O Broad Based <br /> O Sponsored <br /> (Also Complete Part 5.) <br /> <br /> I.D. NUMBER <br />3. Committee Information Treasurer(s) <br /> COMMI]TEE NAM E NAME OF TREASURER <br /> <br /> CITY STATE ZIP CODE - <br /> <br /> MAILING ADDRESS (IF DIFFERENT) NO, AND STREET OR P,O, BOX MAILING ADDRESS <br /> <br /> CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE <br /> <br /> OPTIONAL; FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS <br /> <br /> FPPC Form 460 (8/99) <br /> For Technical Assistance: 916/322-5660 <br /> State of California <br /> <br /> <br />