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COVER PAGE - LONG FORM <br /> <br /> Officeholder, Candidate, ~y~..;.i.t~ <br />· ~ Statement covets pldod Date Stamp <br /> <br /> and Controlled Committee ,,o.__~_~ <br /> Campaign Statement -- Long Form <br /> (~vemment C~e ~runs M2~216'5) th,~ <br /> SEE INSTRUCTIONS ON REVERSE ~ d e~ M I~l~: ~ E~ [ J~ FOr OffK~l U~ Only <br /> <br /> Sup~men~l Pm4~ S~tement ~ich I ~m~t~ From 495 to this statement.) <br /> <br /> Semi-annual S~tement <br /> ~ rminat~ Statement (A~ach i com~t~ From 415 to this Kitement.) ~ment: <br /> <br /> STATE ~ C~ ~ ~YT~ ~ <br /> ~E OF T~R / <br /> <br /> m~ I~ ~ ~ CIm~ s~tame~. I have u~ iii relGl~ dilige~e and to the ~s~ ot my kn~l~e t~ treasurer his used ell <br /> An ~ke~t m u~ w~ c~t,ds I cm~ i~ to t~ ~ of my k~ t~ ifl~ml~ c~i~ ~min <br /> c~te. I (e~i~ ~; ~ of ~rju~ u~r t~ bM Ot ~ S~ of Cilifmnm that the Ior~oing <br /> <br /> Ex~uted on At ~y ~ SLATE <br /> <br /> <br />