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Recipient Committee COVER PAGE <br /> Type or print In ink. Date Stamp <br /> Campaign Statement •- � , <br /> Cover Page �,.w,�,.�?� -�.- rw --. <br /> �� � � � <br /> (Govemment Code Sections 84200-84216.5) : � •' <br /> Statement covers period Date of election if plicab�e �i'�-� � �t' <br /> from January 1,2015 (�onth, Day, ar) p�ge � of 14 <br /> g ��� �� ���� ; For Official Use Only <br /> SEE INSTRUCTIONS ON REVERSE tnrou9n �une 3D,_�,dt,�- 2015 Electi�n � <br /> L Type of Recipient Committee: All Committees—Complete Parts 1,s,a,ellbnC ! 2. Type of Stat ment: l a <br /> ..� <br /> � Officeholder,Candidate Controlled Committee ❑ Ballot Measure Committee ❑ Preelection�e�nt..� . ❑ Quarterly Statement <br /> Q State Candidate Efection Committee � Primarily Formed � Semi-annual Statement � Special Odd-Year Report <br /> � Reca�� Q Co�trolled Termination Statement <br /> (AlsoCompletePartSJ Q Sponsored � ❑ SupplementalPreelection <br /> (AlsoComplatePart6) ❑ Amendment(Explain below) Statement-Attach Form 495 <br /> ❑ General Purpose Committee <br /> Q Sponsored � Primarily Formed Candidate/ <br /> Q SmaB Contributor Committee Officeholder Committee <br /> Q PoliticalParty/CentralCommittee (AlsoCompletePart7) <br /> 3. Committee Information �.D. NUMBER Treasurer s <br /> 1374422 ( l <br /> COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> Committee to Elect Janet Borgens for Redwood Ciry Councit 2015 Hollis Matheny <br /> MAILING ADDRESS <br /> <br /> STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE <br /> Union City Ca 94587 ( <br /> CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER.IF ANY <br /> Redwood City Ca 94063 ( <br /> MAILING ADDRESS(IF DIfFERENT)NO.AND STREET OR P.O. BOX MAILING ADDRESS <br /> CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE <br /> OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS <br /> 4. Verification <br /> I have used al!reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the informa' ntained herein and in the attached schedules is true and complete. I <br /> certify under penalty of perj under he laws of the State of Califomia that the foregoin rue and corr <br /> -"_� <br /> 3 � <br /> Euecuted on ''� gy L�� � <br /> � �� Sig ofTreaswerorAssistantTieasurer <br /> / -S/ / < � !� �L?, "��L-�� <br /> Executed on �� g <br /> �� y Signahue of Controlling Ofllceholder,Candidate,St Maesure Proporrent or Responsible Oficar of Sponsor <br /> Executed on gy <br /> - �� � Signature of CaWnlGng Offi�eholder,Gandidate,Stete Measure Proponerrt <br /> Executed on gY <br /> � Signature otControlfing Otficeholdar,Candidate,State Measure Proponent FPPC Form 460(June/01) <br /> FPPC ToN-Pree Helpline:SB6IASK-FPPC <br /> State of California <br />