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Reci ient Committee COVER PAGE <br /> Campaign Statement Type or print in ink. . ` oate stamp • ' <br /> � �� ' ' ' ' � <br /> Cover Page ' � �. � � <br /> (Government Code Sections 84200-84216.5) � <br /> Statement covers period Date of election if applical�le: � g <br /> Sept 20, 2015 (Month, Day, Year) 0 C T 1 9 2 G 15 Page�! of <br /> from For Official Use Only <br /> SEE INSTRUCTIONS ON REVERSE through �Ct �7, 2015 2��5 E�eCtIOCt �� <br /> ,, .-. . � _ _ , <br /> 1. Type of Recipient Committee: Ali Committees—Complete Parts 1,s,s,and 4. 2. Type of Statement: <br /> � Officeholder,Candidate Controlled Committee ❑ Ballot Measure Committee � Preelection Statement � Quarterly Statement <br /> Q State Candidate Election Committee Q Primarily Formed ❑ Semi-annual Statement � Special Odd-Year Report <br /> Q Recall Q Controlled ❑ Termination Statement ❑ Supplemental Preelection <br /> (AlsoCompletePartS) Q Sponsored <br /> (Also Comp/etaPart 6) ❑ Amendment (Explain below) Statement-Attach Form 495 <br /> ❑ General Purpose Committee <br /> Q Sponsored � Primarily Formed Candidate/ <br /> Q Small Contributor Committee Officeholder Committee <br /> Q PoliticalParty/CentralCommittee (A�soCompletePart7) <br /> 3. Committee Information I.D. NUMBER Treasurer(s) <br /> 1374422 <br /> COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> Committee to Elect Janet Borgens for Redwood City Council 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 all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the inforrry-�Cibn contained herein and in the attached schedules is true and compiete. I <br /> certify under penalty of perjury under t e laws of the State of California that the foregoing s true and correct. <br /> / � � <br /> �-� ,..�-� �+. � <br /> Executed on ( t^ � � By �-- '"� � <br /> D r�, t - ignatuce Treasurero '"sistarkTreasurer <br /> Executed on � G� ._- / ��`�'1 �y�.�' gy ��LL���Z.f� � G /�Slr ��.- �~"'_'., <br /> Date �,�nature of Controlling Officeholder,Candidate,State Measure Proponent or Responsible Officer of Sponsor <br /> :/ <br /> Executed on By <br /> Date Signature of Control�ing Officeholder,Candidate,State Measure Proponent <br /> Executed on BY FPPC Form 460 June101 <br /> Date Signature of Controlling Officeholder,Candidate,State Measure Proponent � ) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC <br /> State of California <br />