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Recipient Committee <br /> Campaign Statement <br /> Cover Page <br /> (Government Code Sections 84200-84216.5) <br /> SEE INSTRUCTIONS ON REVERSE <br /> Type or print in ink. <br /> Statement cover period <br /> from C%� �� ��� <br /> through �d' ' ` �� (� <br /> 1. Ty�7e Of R@Clplellt COt711711tt@@: AII Committees-Complete Parts 1,z,3,and 4. <br /> �j Officeholder,Candidate Controlled Committee <br /> � � � State Candidate Election Committee <br /> � Recall <br /> (Also Complete Pa�t 5) <br /> ❑ General Purpose Committee <br /> � Sponsored <br /> �Small Contributor Committee <br /> Q Political Party/Central Committee <br /> 3. Committee Information <br /> ❑ Primarily Formed Ballot Measure <br /> Committee <br /> 0 Controlled <br /> � Sponsored <br /> (Also Complete Part 6J <br /> � Primarily Formed Candidate/ <br /> Officeholder Committee <br /> (A/so Complete Part 7J <br /> I.D. NUMBER ���^I�� <br /> C� <br /> COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br /> � O�t��� �C-�-c-�,��.'�.C.0 ( � i� <br /> STREET ADDRE55 (NO P.O. 80X) <br /> � ' <br /> CITY STATE ZIP CODE AREA CODE/PHONE <br /> �Ze�.�:C.-ac�CS-�-c.y C�-- °l y 0�� �' <br /> MAILING ADDRESS (IF DIFFERENT O.AND STREET OR P.O. BOX � <br /> CITY STATE ZIP CODE AREA CODE/PHONE <br /> COVER PAGE <br /> Date Stamp <br /> Date of election if applicat�le: �Page� of� <br /> (Month, Day, Year) �J;, ,i 3 ��;;r� Fot Officia� I Use Only <br /> �i � CJtJ <br /> a <br /> �G(3 � <br /> ._ ,. . . <br /> 2. Type of Statement: � • , , ¢ <br /> � Preelection Statement � Quarterly Statement <br /> ❑ Semi-annual Statement � Special Odd-Year RepoR <br /> ❑ Termination Statement � Supplemental Preelection <br /> (Also file a Form 410 Termination) Statement-Attach Form 495 <br /> ❑ Amendment(Explain below) <br /> Treasurer(s) <br /> NAME OF TREASURER <br /> �h���� ���� <br /> MAILING ADDRESS <br /> �( <br /> CITY STATE ZIP CODE AREA CODE/PHONE <br /> `�Jcc,.�t�.��°a�2� C� q�i��2. � <br /> NAME OF ASSISTANT TREASURER, IF ANY ' <br /> MAILING ADDRESS <br /> CITY STATE ZIP CODE AREA CODE/PHONE <br /> OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS <br /> �(�� <br /> 4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to t est of m 4c owl dge tfie infor ation contained herein and in the attached schedules is true and complete. I certify <br /> under penalty of perjury und the law of the State of California that the foregoing is tr e an corr tl� <br /> f] %� � <br /> Executed on__._�� °� � , � B � <br /> r� Da ign ofTrea re orAssistantTreasurer <br /> Executed on �" � By ' a <br /> Date Sig ture f Controlling Offceholder,Candidate,S a e Measure Proponent or Responsible Offcer of Sponsor <br /> Executed on <br /> Date <br /> Executed on <br /> Date <br /> By <br /> Signature of Controlling Officeholder,Candidate,State Measure Proponent <br /> By <br /> Signatureof Controlling Officeholder,Candidate,State Measure Proponent FPPC Fortn 460(January/OS) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) <br /> State of California <br />