Claire 01-01-1996 thru 06-30-1996 Semi-Annual 490

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Officeholder, Candidate, Typeor printin ink. COVERPAGE- LONG FORM a n d C o n t rolled Co m m ittee state..nt cou.. pe,~ D.t, Stamp Campaign Statement -- Long Form f,om~ (Government Code Sections 84200-842165) SEE INSTRUCTIONS ON REVERSE Page ~ of ~ Check one of the following boxes to indkate the type of statement being flied: Date of election if a Pre-election Statement (Month, Day, Year) For Official Use Only Supplemental PrHle~tion Statement (Attach a completed Form 495 to this statement.) Spacial Odd-Year Campaign Report J~L. I 6 i996 Semi-annual Statement Termination Statement (Attach a completed Form 415 to this statement.) ~ any lis Statement ~ou NAME Of OFFICE HOLDER ON CANDiIDATE ¢omm/tteei of wh/ch you have know/edge that are/)r/mar//y formed to rece/ve contr/bi~k:vll o~ to n~ke expenditures on beha/f ofyour canGVd4c~. le. co...,.., i,.D. ND.,. OFFIC~ SOUGH1 De H~LD 0NO. UO~ LOCATION ~ DI~TIIIC7 IiUMREII IF A.ePtJ~LE) RESIOEIfllAL OI1 BUSINESS ADDRESS (NO. AND STREET) NAME OF TREASURER CONTRO4.LED CoMMn'TEEt ~ln'El NAME I I.D. NUMRER COMMITTEE AODIIESS ~lO. AND STREET) I NAME OF TREASURER ~ - COMMn'rEE AOO~SS (NO. AND sTRErr) VIi:b'~JL~a, ~ i , I~IIMANENT~DORESS O4~ TRFJdURER (NC). AND STREET) ~ STATE ~P CODE ARE~ C(X)F~)AYTIME PHONE CITY STATE Z~ COOE AREA ~YTIME PHONE i III Verification I haw uf~l ell realonabl~ dlli~lnce in preparing this statement. I have reviewed the statement and to the ~ of my knowledge the information contained herein and in the attached REhedules is true and comptete.Exm:uted on.~..U..~~Jcertif~ under panalty of paqury under the lewsQf the Steta cifICalifomie that the foregoing~i~tr_ue and correct.At ~ By '///'/~f'~,~t~?~ ::~ DATE CITY AND STATE SIGNATURE OF TREASURER An offkeholder or candidate who control$ I committee must alco verify the campaign statament. I have used all reasonable diligence and to the best of my knowledge the treasurer has used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the i~ati~on con~ained~laereij~n~, the attached schedules is true and complete. I certify u~ler p/malty of perjury under the laws of the State of Celiforni~that the foregoing is true and ;jelr~/laf. / /, _ ~- Executed on_~L~dl)& At~ By ' · ' DATE CITY AND STATE SIGNATURE OF CANDIOATEK)~FICEHOLDER Executed on At By DATE CITY AND STATE SIGNATURE OF CANDIDATE/OFFICEHOLDER Executed on. At By DATE CITY AND STATE SIGNATURE OF CANOIDATE~OFFICEHOLDiR FOR INFORMAT~)N REQUH'-ED TO BE PROVIDED TO YOU PURSUAN1 TO THE INFORMATION PRACTK:ES AC1 OF t~77, SEE INFORMAT~;)N MANUAl ON CAMPAIGN DISCLOSyRE PRC~VlSH;)HS OF THeE POLnICA~ REFORM A~!'.