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Type or print in ink, COVER PAGE - PART 2 <br />Recipient Committee <br />Campaign Statement <br />Cover Page -- Part 2 <br /> Page~ of ~ <br /> <br />4. Officeholder or Candidate Controlled Committee 5. Ballot Measure Committee <br />NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE <br /> <br /> RE§IDENTIAI. JBUSINES~ ADDRESS (N~). AN~D STREET) CITY STATE ZIP Identify the controling officeholder, candidate, or state measure proponent, if any. <br /> NAME OF OFFICEHOLDER. CANDIDATE OR. PROPONENT <br /> <br /> not included in this consolidated statement that are controlled by you or which are primarily OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY <br /> formed to receive contributions or to make expenditures on behalf of your candidacy. <br /> <br /> COMMITTEE NAME I.D. NUMBER 6. Primarily Formed Committee List names of officeholder(s) orcandidate(s) <br /> for which this committee is primarily formed. <br /> <br /> NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD <br /> NAME OF TREASURER CONTROLLED COMMITTEE? [] SUPPORT <br /> <br /> [] YES [] NO [] OPPOSE <br /> <br /> COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [] SUPPORT <br /> [] OPPOSE <br /> <br /> CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [] SUPPORT <br /> [] OPPOSE <br /> <br /> Attach continuation sheets if necessary <br />7. Verification <br /> <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the informati~ntained herein and in the attached schedules <br /> is true and complete, I cedify under penalty of perjury under the laws of the State of California that the foregoing is truend correct, <br /> <br /> Executed on ~/~¢'~ By <br /> '/ i' OATE ~ f--~G.,~I~U~,~T~;~SU R E R OR A S SiS TANT T R E A S U R E R <br /> <br /> Executed on '7/~,~/~) By '~'/~'~'~"-L~~ <br /> DATE SIGNATURE OF CON~'ROLLINC OFFI(~EHOLDE~, CANDIDATE, STATE MEASURE PROPONENT OR RESPONSIBI E OFFICER OF SPONSOR <br /> <br /> Executed on By <br /> DATE SIGNATURE OF CON[ROLLING OFFICEHOLDER, CANDIDA]E STATE MEASURE PROPONENT <br /> <br /> Executed on By <br /> DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT <br /> <br /> FPPC Form 460 (8/99} <br /> For Technical Assistance: 9161322-5660 <br /> State of California <br /> <br /> <br />