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Recipient Committee <br />Campaign Statement <br />Cover Page <br />(Government Code Sections 84200-84216.5) <br />Type or print in ink. <br />Date of election if applic Is: <br />(Month, Day, Year) <br />2. Type of Statement: <br />❑ Preelection Statement <br />® Semi-annual Statement <br />❑ Termination Statement <br />❑ Amendment (Explain below) <br />Statement covers period <br />from January 1, 2017 <br />SEE INSTRUCTIONS ON REVERSE through June 30,2017 <br />1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4. <br />® Officeholder, Candidate Controlled Committee [] Ballot Measure Committee <br />Q State Candidate Election Committee Q Primarily Formed <br />Q Recall Q Controlled <br />(Also Comple(e Psd5) O Sponsored <br />Wsc romdere Part sl <br />❑ General Purpose Committee <br />Q Sponsored <br />Q Small Contributor Committee <br />Q Political Party/Central Committee <br />❑ Primarily Formed Candidate/ <br />Officeholder Committee <br />(Also Camplele Par7) <br />3. Committee Information D. NUMBER <br />1374422 <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMIT'I �) <br />Committee to Elect Janet Borgens for Redwood City Council 2015 <br />STREET ADDRESS (NO P.O. BOX) <br /> <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />Redwood City Ca 94063 ( <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX / E-MAIL ADDRESS <br />Treasurer(s) <br />COVERPAGE <br />Date Stamp e <br />RWA <br />2001/02 4691 <br />RECEIVED FORM <br />JUL 11 2017 Page 1 of 4 <br />F� Official Use Only <br />:Hy of Redwood Qty <br />:� c_.:. J <br />❑ Quarterly Statement <br />❑ Special Odd -Year Report <br />❑ Supplemental Preelection <br />Statement - Attach Form 495 <br />NAME OF TREASURER <br />Hollis Matheny <br />MAILING ADDRESS <br /> <br />CITY STATE ZIP CODE <br />AREA CODE/PHONE <br />Fremont Ca 94536 <br />( <br />NAME OF ASSISTANT TREASURER, IF ANY <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />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 th nformation contained herein and In the attached schedules is true and complete. I <br />certify under penalty of p rjury under the laws of the State of Califomia that the foregoi true and correct. <br />Executed on (// 13 <br />���eM// - nature ollr sfantTrea/s/urer <br />Executed on / By M1IP M <br />Data of 'd I,p Mer, Ce dat6 'I p na esponsaMOficxofBPonsor <br />Executed on By <br />Data Signature orContrd4g Oacerwlder, CanibMab, Slate Measure Pmponent <br />Executed on Date By SlgnaturecfCaNmlhM Officeholder, Canodate, State MessumPropormt FPPC Form 460(Junel0l) <br />FPPC Toll -Free Helpllne: 866/ASK-FPPC <br />State of California <br />