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Type or print in Ink. COVERPAGE -PART2 <br />Recipient Committee CALIFORNIA <br />Campaign Statement FORM ' • <br />Cover Page -- Part 2 <br />Page 2 of 3 <br />5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee <br />NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE <br />OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) <br />RESIDENTIALIBUSINESS ADDRESS (NO AND STREET) CITY STATE ZIP <br />Related Committees Not Included in this Statement: List any committees <br />not included in this statement that are controlled by you or are primarily formed to receive <br />contributions or make expenditures on behalf of your candidacy. <br />COMMITTEENAME LD NUMBER <br />NAME OF TREASURER CONTROLLED COMMITTEE? <br />❑ YES ❑ NO <br />CCMMITTEEADDRESS STREETADDRESS (NO P.Q. BOX) <br />C #TY STATE ZIP CODE AREA CODEIPHONE <br />COMMITTEE NAME I.D. NUMBER <br />NAME OF TREASURER <br />L j YES NO <br />COMMITTEE ADDRESS STREET ADDRESS (NO PO. BOX) <br />CITY STATE ZIP CODE AREA CODEIPHONE <br />BALLOT NO OR LETTER I JURISDICTION ❑ SUPPORT <br />❑ OPPOSE <br />Identify the controlling officeholder, candidate, or state measure proponent, if any. <br />NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT <br />OFFICE SOUGHT OR HELD <br />DISTRICT NO IF ANY <br />7. Primarily Formed Candidate /Officeholder Committee List names or <br />olficeholder(s) or candidates) for which this committee is prfmadly tanned <br />NAME OF OFFICEHOLDER OR CANDIDATE <br />OFFICE SOUGHT OR HELD <br />❑ SUPPORT <br />❑ OPPOSE <br />NAME OF OFFICEHOLDER OR CANDIDATE <br />OFFICE SOUGHT OR HELD <br />❑ SUPPORT <br />❑ OPPOSE <br />NAME OF OFFICEHOLDER OR CANDIDATE <br />OFFICE SOUGHT OR HELD <br />❑ SUPPORT <br />❑ OPPOSE <br />NAME OF OFFICEHOLDER OR CANDIDATE <br />OFFICE SOUGHT OR HELD <br />❑ SUPPORT <br />❑ OPPOSE <br />Attach continuation sheets if necessary <br />FPPC Form 460 (JanuarylD6) <br />FPPC Toll -Free Helpline. e661ASK -FPPC (86W275-3772) <br />State of California <br />