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Officeholder, Candidate, Typa Of Fint in Ink. COVER PAGE - LONG FORM <br />(~nd Controlled Committee St~tem~atceversparled DateStamp <br />Campaign Statement -- Long Form ,,~.~ <br /> <br />Check one of the following boxes to indklte the tyl~ of stotement being flied: <br /> (Month, Diy, Yelr) ' ! <br /> 8 Pel-ei~tmn Statement ~ 1 1~9(~ t FOr Officiel Us~ Only <br /> Supplemental Pea*election Statement (Attach i completed Form 495 to this statement.) ~_.: <br /> I-]_ Sp~ial Odd-Yelr Campaign RepMt <br /> ~r $emi-~nnual Statement <br /> [~ TerminatmnStatament(At~ach~completedFocm41Stothisstatament.} C;',Y 0¢ nBDWOC.D OITY / <br /> ~ TY CLERK · <br />I, Officeho-'~r..Cindi~aie, and Controlled Con~n~ittee II Other Committe(-~l lot in¢ludedin <br /> Included in this Statement <br /> NAME Of OetN. InOLDEI ON CANDI)Ali camm/tiNs of wNch you have know~ d~t eel pdma~y ¢Mmed to rece/ve contrlbutiom <br /> <br /> Lhu~V ~ a ~uNdcO~'~.~ ~el~if~i ' ~deT~n~P ~fl~ i~e~r;:~ 7n~h~ill hw~l ~): :~f%~if:~:nt~t~t i~e.O the best aOfi.~or¥~ ~r~ ~.U~ Off~e~FO~ COntained heelin and in tbe attached ~h~ule$ is <br /> rAena soedfnkl/~_r .of'.~.~i ~ .1~1 .k~l..._ _t_~l.~_l _l~_ .~.l. a _G~I_. m. ? .ult als~,, .,verify the ¢lmpal,g, n ,.tame.. I have u~d ell rla.nable diligence and to the best of my knowledge the treasurer has u~e, all <br /> v ),~.. ~u~1u~u~F/en~ny~er~uryun~rtn~w~th~$t~te~C~n~th~tthef~re~ng~tru~nd~rel~t~ ,, ) /,/ . <br /> <br /> / ~ATE mY AND STA?! gGK4TIJA~ Of C~NDIT)At EK)F FIC~HOLOf R <br /> Executed on. At By <br /> DA. OTY AND STA;E ~G)MTU~ Of <br /> Executed off At 8y <br /> <br /> <br />