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Officeholder, Candidate, ~ype or print in ink. COVER PAGE- LONG FORM <br /> and Controlled Committee Statement covers period Date Stamp <br /> Campaign Statement -- Long Form <br /> SEE INSTRUCTIONS ON REVERSE through <br /> <br /> Chick one of the followin~ boxes to indicate the type of statement being filed: Date of election if applical~e: ~/r'~ ~ I *) I [©~ For Official Use Only <br /> Pre-election Statement (Month, Day, Year) <br /> Supplemental PrHleCtion Statement (Attach · completed Form 495 to this statement.) <br /> Special Odd-Year C~mpaign Report CIE ¥ 0F REDWOOD CI[Y <br /> Semi-annual Statement CITY CLERK <br /> Termination Statement (Attach i corn pleted Form 415 to this statement.) <br /> Lbt any other <br /> Im lis Statement coma/trees not included in this consolldated statem~nt that are controlled by you and any <br /> NAME OF OFFICEHOU~R OR CANDIDATE committees of wlWch you ha ye knowledge that ar~ I~maril~ formed to receive (ontdbuttom <br /> o~ to make expenditures on behalf of your candidacy. <br /> <br /> MIKE SOU6HT oe MU) (INCLUI)~ LOCATION ANO DtSTNCT NUMRER IF AP~LIC~ILE) <br /> <br /> I~MDENTIAL OR IUS~SS ADoaEss (NO. AND STREET) NAMt OF TREASURER CONTROLLID COMMITTEE~ <br /> C~TY STATE ~P COOl AREA CODE/DAYTIME PHONE COMMITTEE ADDRESS (NO. AND STREET) <br /> <br /> COMMITTEE NAME ' I I:b. NUMBER CITY STAT! ZIP CODE AREA CODF~)AYTIMI PHONE <br /> <br /> · COMMITTEE NAME I.D. NUMIER <br /> CO~MI~I'E! ADD~ESS IND- AND SIREET) <br /> <br /> CITY STAll liP COO~ AREA COO~/OAYTIMI PHONE NAME OF TREASURER CONTROLLED COMMITTEE ? <br /> NAME OF TREASURER COMUfnll ADD. SS (NO. AND STMET) .,, <br /> PERMANENT AOOI~SS OF TI~A~4JRER (NO. AND STREET) CITY STATE ZIP CODE AREA CODE~)AYTIMI PHONE <br /> <br /> C~Y STATE ZIP COOl AREA COOF~)AYTIME PHONE <br /> Attach ~dd~tional information on appropriately labeled continuation sheets. <br />III Verification <br /> I have used all reasormble diligence in preparing this statement. I have reviewed the statement and to the be~t of my knowledge the~info~mation c~ntained herein and in the attached schedules is <br /> true and completl~ I cMtify under penalty of per~ur~ undeT the lawns of the State of California that the foregoing is true a~orrect~. <br /> <br /> ~ ~ DAlE ' CITY ~ND STAT( ' <br /> S,GNAruRE OF TREASURE~ <br /> <br /> An officeholder or U)odldata who controls I committee must also verify the campaign staternant. I ha~e used all reasonable diligence and to the best of my knowledge the treasurer has used all <br /> reasonable diligtnce in I)TIpering this statement. I hive reviewed the statement and to the best of my knowledge the infoFmation contained herein and in the attached schedules is true and <br /> complete. I certify~nder penalty of perjury und~lT the laws of the State of California that the foregoing is true af~d correct <br /> <br /> STAT! .... S~GNA;URE OF ~AN~DArl/OFFKIHOU)~R <br /> Executed on. At By <br /> DATE CJTY AND STATE S~GNATURE OF ~NDmATF~)FF~IHOLDIR <br /> <br /> Executed on. At By <br /> DATE CITY AND STATE $1GNAIURE OF (ANI~IB&IE/OFFKEHOLDER <br /> <br /> FOR INFORMATION REQ~IRID TO I[ ,ROVID[D rD YOU PURSUANI TO THE INFORMATION PRACTICES Ad OF ISlT, SEE INFORMAltON MAN. I~IA[ ~N__CA_M~PA~I~N_~I~[LOSUR! PROVISIONS OF IH[ POLl]KAL R[FORM~AC~T <br /> <br /> <br />