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Officeholder, Candidate, Type or print in ink. COVER PAGE-LONG FORM <br /> 'and Controlled Committee Statement covers period Dot( ~tam <br /> Campaign Statement -- Long Form <br /> (Government Code Sections 84200-8421 $.5) <br /> SEE INSTRUCTIONS ON REVERSE I <br /> Check one of the fo::~w;n~ boxes to indicate the type of statement being fi~: Date of election ff of ~ <br />  Pre-election Statement (Month, Day, Year) Official Use Only <br /> Supplemental Pre'election Statement (Attach a completed Form a95 to this statement.) OCT ~ ~ 1995 <br /> Special Odd-Year Campaign Report <br /> Semi-annual Statement .~ <br /> Termination Statement (Attach i completed Form 41S to this ~totement.) 0 ~ . I ~ T y 0 [ R ~ D W 0 0 ~ C ii <br /> <br /> L/st any other <br /> Includ S Statement cammiflees not/nduded/n statement that 'you and any <br /> NAME OF OFFICEHOLDER OR CANGiGATE camm/flees ofwhlchyou ha primarily f contribuOom <br /> <br /> OFFICE S4)U~HT O~ HELD (INCLUDE LOCATIO~ AND DISTI~"T NUMBER IF APIII'LICABLE) CC~;,;.-'TEE NAME I.D. NUMBER <br /> <br /> RESIDENTIAL O4~ IUSII~ESS <br /> I ~'4"'g Gorg~ CDNT,o,.,.,D CO.M,.,,, <br /> 0 YES 0 <br />  STATE Zl~ CODE AREA COOE/OAYTNdE PHONE CC~.-'-'J..~ ~ez ADDRESS (NO. AND STREET) <br /> <br /> COMMITTEE NAME <br /> I I.D. NUMliER CITY STATE <br /> I CC~.;,'TTEE ADDRESS (NO. AND STREET) CC%'.:.::i itt NAME <br /> <br /> CITY ~IP CODE AREA COI~/~AYTN~E ~ .u_A.~u.~ Of TI~A~4)I~R <br /> . CONTRO(LED COMMITTEE? <br /> NAME O~ TREASURER /' ['1 YEs I[~ NO <br /> <br /> PERMANENT A~T~iSS Of TREASUI~R (NO, AND STREET) CITY STATE ~ COOt <br /> t4 --A COD,,DA,,., ,',-- <br /> <br /> STATE ZNI) COO~ AREA CODfJOAYTIM! <br />I/I Verification ! ' <br /> I have used all reasonable diligence tn preparing this statement. I ' ' <br /> have ray,wed the statement and to the best of my knowledge the information contlined herein and in the attached schedules is <br /> i true and complete. I certify under I~nalty of perjury under the lav~s of the Stere of California that the foregoing is true and correct. <br /> <br /> ' DATE ~ CITy AND STATE <br /> SIGNATURE DE TREASURER <br /> An officeholder M clndldate who controls a committee must also verify the campaign statement. I have used all reasonable diligence and to the best of my knowledge the treasurer has used all <br /> reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained herein and in the attached schedules is true end <br /> complete· I Certify under penalty of perjury under t,~ lav~s of the St~1 <br /> E.cutedon A, c4 ,y <br /> ! DATE. ~ . CiTY AND STATE / SIGNATURE OF CANDIDATE/OfFICEHOLDER <br /> Executedon (0/~ (:~ /~ At By <br /> DATE CITY AND STATE SIGNATURE OF CANDIDATEIOfEICEHO(DER <br /> Executed on At <br /> DATE CITY AND STATE SIGNATURE OF CANDIDATEIOfFICEHOtOER <br /> FDR INFORMATION REf34JIRED TO lie I~OVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT DE 14~77. SEE INFORMATION MANIslAL ON CAMPAIGN DISCLOSU~E PROVISIONS Of THE POI. iTICAI. REFORM ACT <br /> <br /> <br />