Laserfiche WebLink
Recipient Committee <br />Campaign Statement — Short Form <br />SEE INSTRUCTIONS ON REVERSE <br />For use by recipient committees that have not received a <br />contribution or other receipt that must be itemized, have not <br />received or made loans, and have no outstanding accrued <br />expenses. <br />Type or print in ink. <br />Statement covers period <br />front /-/-/6 <br />through 6 ` _!; 0 ' /4 <br />1. Type of Recipient Committee: <br />❑ Ballot Measure Committee �e I Purpose Committee <br />Q Primarily Formed Sponsored <br />Q Controlled Q Small Contributor Committee <br />Q Sponsored <br />❑ Primarily Formed Candidate/ <br />Officeholder Committee <br />3. Committee Information <br />I D NUMBER <br />`3'4-7 I i 5" <br />COMMITTEE NAME <br />iZe�wooci C � �y Tewc f's asso IInln <br />Fol 4 -cod Ae_+iat% F%An � <br />9MP <br />Dabs of election 1 applicable:pk;', j I �� 1i) <br />(Month, Day Year) <br />! <br />2. Type of Statement: <br />❑ Pre-election Statement <br />,JSC'Semi-annual Statement <br />❑ Termination Statement <br />❑ Amendment (Explain) <br />(Also check type of statement you are amending) <br />Treasurer(s) <br />NAME OF TREASURER <br />S+eveA A G4t^(Ay <br />MAAILINNGAADDR(a hESS (, (_ <br />STREET ADDRESS (NO P,O. BOX) h e-5 R01 -e <br />33s- �atkes4l of�e. D f�• � • f • Cr��rY//�, STATE ZIP CODE �AREA COD <br />E/PHONE a <br />CITY STATE ZIP CODE AREA CODE/PHONE -BVI A-4 � e , 54 0 eh qy/) <br />Sao ` fC�r'�L�1 SGO ,E � 3Z NAME OF ASSISTANT TREASURER, IF ANY <br />c I %15-A69 -5S?8 <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILINGADDRESS <br />P•0• zov 6/c/) s <br />CITY %%�� STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE <br />QPTINA���E-MAI�ADDRESS C14 9Y06( OPTIONAL: FAX/ E-MAIL ADDRESS <br />m rmv.t"ray 3s Q gme.L • c ►m <br />4. Verification <br />I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein is true and complete. I certify <br />under penalty of perjury under the laws of the State of Califomia that the foregoing is true and correct. <br />1` <br />Executed on v -2O - /6, By ' ' ` le-4� <br />DATE SW4AI�p( OF TREASURER OR ASSISTANT TREASURER <br />JI/Vf%l fV(VYI <br />Page L_ of --3 <br />For Oftia1 Use Ordy <br />❑ Quartedy Statement <br />❑ Special Odd -year Report <br />❑ Supplemental Pre-election <br />Statement - Attach Form 495 <br />Executed on By <br />DATE SIGNATLgRE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR <br />Executed on By <br />DATE SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE, STATE MEASURE PROPONENT <br />Executed on By <br />DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT <br />FPPC Form 450 (January/05) <br />FPPC Toil -Free Helpline: 866/ASK-FPPC (8861275.3772) <br />