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RecipientCommittee T = COVERPAGE <br /> _ <br /> ype or print in ink. Date Stamp �� � <br /> Campaign Statement ; ' �. � • 1 <br /> Cover Page <br /> (Govemment Code Sedions 84200-84216.5) : <br /> Statement covers riod Date of election if a Gcable: " ` " �' Page� of�_ <br /> Pe PP r',tl'.a � �+.1�� <br /> from <br /> 1/1/12 (Month, Day,Yeaf� For Offiaal Use Only <br /> throu h 6/30/12 11/8111 � ". <br /> SEE INSTRUCTIONS ON REVERSE 9 , � '? <br /> � � � .��- �..:�� ' <br /> 1. Type of Recipient Committee: an comm�t��-canpiere Pans�,z,a,ana a 2. Type of Statement: <br /> � Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarteriy Statement <br /> �State Candidate Election Committee Committee � Semi-annual Statement ❑ Special Odd-Year Report <br /> Q Recall Q Controlled Termination Statement <br /> (AlsoCompletePaRS) S onsored � ❑ SupplementalPreelection <br /> � P (Also file a Form 410 Te�mination) Statement-Attach Form 495 <br /> (Also Compfete Pan6) <br /> ❑ General Purpose Committee ❑ Amendment(Explain below) <br /> Q Sponsored � Primarity Formed Candidate/ <br /> Q Small Contributor Committee Qfficehokler Committee — <br /> Q Political Party/Central Committee (aso cam�ete Part i� <br /> 3. Committee Information �•D. NUMBER Treasurer(s) <br /> 1255762 <br /> COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> lan Bain for City Council 2011 Lorianna Kastrop <br /> MAILING ADDRESS <br /> <br /> STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE <br /> Redwood City CA 94063 <br /> CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASS�STANT TREASURER,IF ANY <br /> Redwood City CA 94061 <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 CODEJPHONE <br /> OPTIONAL: FAX 1 E-MAILADDRESS 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 information contained herein and in the attached schedules is true and complete. I certify <br /> under penalty of perjury under th�e laws o�the State of Califomia that the foregoing is true and correct. r °` <br /> ' �.,. �_.,........ <br /> -, ,r � \....� —'-,�... . � . � <br /> ,'� �'-� ,'�.� .:�.. <br /> EXecuted on �� . By �. -5ignatureofTreasurerorAssistantTreasurer <br /> �`7 �� '�- � �i� <br /> EXeCUted on � By �SignatureMCoMrollingOffice oWer,Candidate,SiateMeasureProponentorRespans�bleOfficerofSponsor <br /> Executed on By <br /> Date Sgnature of Controlling Oficeholder,Candidate,State Measure Proponent <br /> Executed on BY <br /> py� SignatureaCanvoll�gO�oenolder,Candidate,stateMeasureProponeM FPPC Form 4B0(January105) <br /> FPPC Toll-Free Helpline:8661ASK-FPPC(8661275-3772) <br /> St�*e of Califomia <br />