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Officeholder, candidate, Type or print in ink. COVER PAGE- LONG FORM <br />and Controlled Committee Statement covers period DateStamp <br />Campaign Statement -- Long Form from ~~ ~ <br />(GovernmentCodeSections84200-84216.5, (~/,~/~,,~::) ~1~ ~ ~ D 1~ [~ L~ / of <br />SEE INSTRUCTIONS ON REVERSE through , / , <br />Check one of the following boxes to indicate the type of statement being filed: Date of election if applicable: For Official Use Only <br /> 8 Pre-electionStatement (Month, Day, Year) ' ~ ~ 9 ~ <br /> Supplemental Pre-election Statement (Attach a completed Form 495 to this statement.) <br /> <br /> [] Semi-annual Statement // ~' CiTY OF REDW000 ~ <br /> L~] Termination Statement (Attach i completed Form 415 to this statement ) CITY t~J ;RK I <br />I, Officeholder, Candidate, and Controlled Committee II Other Committees Not Included in this Statement: <br />Included in this Statement committees not included in this consolidated statement that are controlled by),ou and any <br /> NAME O; OFFICEHOLDER OR CANDIDATE . . ! committees of which you have knowledge that are primarily formed to receive contributions <br /> <br /> OFFICE SOUGU~,,OR HeAD (INCLUOF'LOfA~ION ANC~DISTRICT NUMBER IF APPLICABLE) COMMITTEE NAME I.O. NUMBER <br /> <br /> RESIDENTIAL OR BUSINESS ADDRESS ~ <br /> <br /> [] YES [] NO <br /> CITY /~ ]'- j .~ (~ STATE ZIP CODE AREA CODFrJOAYTIME PHONE COMMITTEE ADDRESS (NO. AND STREET) <br /> <br /> COMMIfTEE NAME , ~ ~ /{ ,/ ~, .//.~ / } 'I. Crl'~ STATE ZIP CODE AREA CODE/DAYTIME PI. lONE <br /> I <br /> COMMITTEE ADDRESS /' ,(NQ. D. NUMBER <br /> <br /> CITY p / / /~ I' STATE ZiP CODE AREA CODE/DAYTIME PHONE NAME Of TREASURER CONTROLLED COMMITI'EE? <br /> <br /> NAME OF ~ASURER . ~- . ( ./ COMMrrrEE AOORESS (NO. ANO STREE;} <br /> <br /> PERMANENT ~[)ORESS OF IREASURER (NO. AND STREET).. CffY STATE ZIP COD[ AREA CODE/DAYTIME II~tO~E <br /> CITY ZIP CODE AREA CODE/DAYTIME PNONE <br /> <br /> I have used all reasonable diligence in preparing this statement. I have reviewed the statement and t< ~ in the attached schedules is <br /> true and corn plate. I/certiJy under penalty of perAUry ul~der the laws of the State of California that thd ~ <br /> Executedon~12,ff'.q L ' At ' ./F ~- J,..,~I ~,~ ~ ~ - <br /> --L/ DA(rE ' ' ClfY AND STA~'E SIGNATURE OF TREASURER <br /> An officeholder or candidate who controls a committee must also verify the campaign statement. I reasonable diligence and to the best of my~nowledge 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 infor/r~atioJ~ contained h~e~ein and n the attached schedules and <br /> complete. ~certifyunF~erpqna~ty~fperjuryunder~the~w~ftheState~f~a~if~miat~atthef~reg~ingir~tru~ndc~rrec~`~C~ / ,,~ ~ ? / istrue <br /> <br /> · -- [ OAI~E[ CITYANOSTATi ( -- REOF ~ <br /> E~ecuted on At <br /> DATE CITY AND STATE ~_GNATURE OF CANDIDATE/OFFICEHOLDER <br /> Executed on At By <br /> DATE CITY AND STATE SIGNATURE OF CANDIDATE/OFFICEHOLDER <br /> FOR INFORMAYION REnU'RED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLITICAL REFORM ACT <br /> <br /> <br />