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· ..~.. v ... nec"'~ent ~omma+ee Type or print in Ink. COVER PAGE - PART 2 <br />Campaign Statement <br />Cover Page -- Part 2 <br /> <br />4. Officeholder or Candidate Controlled Committee 5. Ballot Measure Committee <br /> <br /> NAME OF OFFICEHOLDER OR CANDtDATE NAME OF BALLOT MEASURE <br /> <br /> RESIDENTIAL/BUSINESS A DDRES~ (INO. AND STREW:T) CITY , STATE ZIP <br /> <br /> R®lated Committees Not I.¢l,,ded I~ tl~i~ Statement: <br /> n~ #~u~e~/~ ~ co~o/~ ~eme~t ~eat am coet~tbyj~u or~ are p~f~/y OFFICE SOUGHT OR HELD I C~STRICT NO. iF ANY <br /> I <br /> COMMI'ITEENAME I.D. NUMBER 6. Primarily Formed Committee <br /> <br /> NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [] SUPPORT <br /> N~ME OF TREASURER CONTROLLED COMMITTEE? <br /> <br /> [] YES [] NO [] OPPOSE <br /> COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BO~ NAME OF OFF~EHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [] SUPPORT <br /> [] OPPOSE <br /> <br /> CITY STATE ZiP CODE AREA COOE/PHONI= NAME OF O~FICEHOLOER OR CANDIDATE OFFICE SOUGHT OR HELD [] SUPPORT <br /> <br /> AttsCh conenua~k~ sheets/fnecessaq/ <br />7. Verification <br /> <br /> I have used all reasonable diligence in preparing and revieWh'~g this statement end to the best of my knowledge the information contained herein and in the attached sche(~utes <br /> is true and complete. ! certify under penalty of perjury under the laws of the ~ate of California that the foregoing is I~e and correct. <br /> <br /> · / l~ ~ 5~(~NATUREOFC~iTROLL~NGOFF~EH~L~EF~CAND~DA~$T^?E~REPR(~:~NENTORRE`c:PONSiBU~OFF~E~OF$PONSOR <br /> Ex~cu~ed on By <br /> DA?E ,,C.,kaNATURE OF CONTRET~LIN~ OP~CEHOLDER, CAN[~DATE, ~'iA~,r E MEA.c~URE pI~ONENT <br /> <br /> Executed on By <br /> DATE SIG~ATURE OF CON"~:~UN~ OFFICEH(~DER. CAND~OATE, STATE MEASURE PRO~3NENT <br /> <br /> F~C Form 460 (8/99) <br /> For Technical As~istance: 916f322-5660 <br /> State ~ California <br /> <br /> <br />