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Reci ient Committee COVER PAGE <br /> P Type or print in ink. ��� <br /> I <br /> CampaignStatement ������� �� , • i <br /> �Cover Page � <br /> (Govemment Code Sections 84200-84216.5) • <br /> Statement covera period Date of election if applicable: ���a Q 1 201 � 1 5 <br /> January 1,2016 (Month, Day,Yearj Pa of <br /> from For Offi al Use Only <br /> SEE INSTRUCTIONS ON REVERSE through �une 30,2�16 G"�"��'�;`�N`'"�� ;�� <br /> Gi;r•�C:��rk <br /> 1. Type of Recipient Committee: All Commit6ess—Complete Parts 1,2,a,and 4. 2. Type of Statement: <br /> � Officehoider,Candidate Controlled Committee ❑ Ballot Measure Committee ❑ Preelection Statement � Quarterly Stateme�t <br /> Q State Candidate Election Committee Q Primarily Formed � Semi-annual Statement ❑ Speciai Odd-Year Report <br /> Q Recall Q Controiled Termination Statement <br /> (AlsoCompletePartS) Q Sponsored � ❑ SupplementalPreelection <br /> (AlsoCompletePart6) ❑ 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 /> �PoliticalPartylCentratCommittee (AlsoComp/efePart7) <br /> 3. Committee information �•D. IJUMBER 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 Ciry Council 2015 Hollis Matheny <br /> MAILING AODRESS <br /> <br /> STREET ADDRESS(NO P.O.BOX) CITY STATE 21P CODE AREA CODE/PHONE <br /> Fremont Ca 94536 ( <br /> CITY STATE ZIP CODE AREA CODElPHONE NAME OF ASSISTANT TREASURER, IF ANY <br /> Redwood City Ca 94063 ( <br /> MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O. BOX MAIL{NG 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 ADORESS <br /> 4. Verification <br /> i have used all reasonable diiigence in preparing and reviewing this statement and to the best of my knowledge the in ation contained herein and in the attached schedules is true and complete. t <br /> certify under penalty of pery'ury under the taws of the State of Califomia that the foregoin ' tru and co . <br /> Executed on By �� <br /> � � -� SignaWieofT ror 'atan , rer <br /> . 4 <br /> ���O� Date By SignatureofConiropingOtficehoWer,Candidate,State roponeMOrRespons�leOlficerofSponsor <br /> Executed on � By Signaturo otControl6rg Officehoker,CarMidak,State Measure Pmponent <br /> ����o� oate By sipnahxe orConad6ng oficenoider.Candidete,scate rneasure aroponent FPPC Form 460(Junel0l? <br /> FPPC Toll-Free Helpline:8661ASK-FPPC <br /> State of California <br />