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Officeholder, Candidate, Typeor printJ~n ink. COVER PAGE- LONG FORM <br /> Statement covers period Date Stamp <br />and Controlled Committee <br />Campaign Statement -- Long Form ,,om 7 <br />(Government Code $~.-tions 84200-642165) <br />SEE INSTRUCTIONS ON REVERSE throug } ., <br />Check on~ of the following boxes to lndkate the type of statement being filed: <br /> <br /> Supplemental Pre-election Statement (Attach a completed Form 495 to this statement.) <br /> <br />I, Officeholder. C~ndidate0 and Controlled ¢ommKtee ~ment: <br />In cluded in this Statement co~m.~ees not i~l~d in t~ c~at~ .ate~nt ~t are (~trolled by y~ 4~ any <br /> c~m~ees of ~h you have k~l~e that ere ~a;tly fmm~ <br />NAME OF ~FEIHO~il O~ ~N~ATE ~ to make executes ~ ~ff of y~r <br /> <br /> (~TROLLED <br /> ~ C~ ~ C~AYT~E ~i C~[[ ~SS (~. AND ST~ <br /> <br /> COMMI~E E ~ME ~/~ I.~. ~R ~ STATE <br /> <br /> ~l STATE Z~ C~ ~l C~YT~E ~ ~[ M T~I C~AOLLED CffiM~EE <br /> ~E OF TRE~URER '"~ <br /> ~ ~SS ~ T~A~ ~. ~ SleET) ~ STATE <br /> <br />III Verification <br /> I have m4d ell reasonable diligence in preparing this statement. I have reviewed the statement and to the be~t of my knowledge the information contained herein and in the attKhed Khedule~ is <br /> true and (om ple~.)~ un~r ~na~ of ~rjury un~r the la~s of the $~te of California that the for~ng i~ tr~e e~rr~. <br /> <br /> An officehoMer m ~Mate who contfMs a comm~ee must also verify ~ campaign statement. I have u~d all reasonable d~nce and~the ~ o~wledge the treasurer has used all <br /> reachable dihge~e in pre.ring this statement. I have reviewed the statement and to the ~ of my kn~ledge the inf~~nt~ h~ ~~ached ~hedules is true and <br /> complete. I ce~i~ u~r ~na~y of ~rju~ under the laws of the State of Calif~ma that the foregoing is true I~ cor~ <br /> <br /> ~ 'DATE CflY A~ STA~ <br /> Executed on At By <br /> DATE CflY AND STATE SIGNAIU~ Of ~NDID&TE~F~EWDEA <br /> <br /> Executed on At By <br /> DATE CITY AND STATE SIGNAI UAE <br /> <br /> fO~ INf~ATION ~l~O TO BE PAOVIDEO 10 Y~ PURSUANT lO TH~ IN~OMAT~ P~KES A~ Of 1~7, SIr INFORMAIlON MAN~AL ~N ~MPAIGN OlSCLOSU~I PROVISIONS ~ I~E POLIT~L ~EFOAM A~ <br /> <br /> <br />