Laserfiche WebLink
Supplemental Independent Type or print in ink. S'JPPLEMENTAL INDEPENDENT EXPENDITURE <br /> Expenditure_~.,,Reno.'* Amounts may be rounded Report cove rs period ..... ~ ...... I...~ <br /> <br /> SEE INSTRUCTIONS ON REVERSE througtt /0 -/~d-~ Page ~ Of. <br /> <br /> , <br /> V Filing Officers Enter the official title and ~dress of each filing officer with whom the most recent ~mpaign statements h~ve been filed. <br /> <br /> 1) OF~C~ TI~E OF FILING ~FICER . · <br /> <br /> AODRES~ -~ ~ / ~' __(NO. ~D STREET) <br /> <br /> CI~ <br />  STATE ZIP ~DE 01~ STATE ZIP CODE <br /> <br /> 2) OFFICIAL TI~E OF FILING OFFI~ER .... . 4) OFFICIAL TITLE OF FILING OFFICE R <br /> <br /> C~ <br /> <br />VI Summa~ <br />~. lotal i~de,ondant e~.diture~ ~do o, $~ O0 or ~o. this pe~. {,a, IV.) ........................................................................................ $ / / ~ ~ <br />2. Total independent ex~nditures under $100 made this pe~. (Not iterated.) ....................................................................................... $ ~ <br />3. Total independent expenditures (Add Unesl + 2.) ....................................................................................................................... TOT~ $ .. / / ~ ~' / <br />- <br />VII Verification <br /> I have ~ed all reasonable diligence in pmpadng this statement. I have reviewed the statement and to the best of my knowledge the info~atio~ contain~ herein is <br /> t~e and ~te./I ce~nder~. ~[ penalty of p~rju~ under ,he la~s of the State of California that ~e foregoing is tree and correct. <br /> <br /> ~ officeholder, candidate, or state measure Proponent who con,Dis a commiffee must also veri~ ~e campaign statemenL I ha~ used all rea~nable <br /> diligence and to the ~st of my kn~edge the treasurer has used all reasonable diligence in pmpadng thi~ statement. I have mview~ the sta~nt and to ~e ~st <br /> of my knoW,ge ~e info~ation ~ntain~ herein is ~e and complete. I ce~i~ under penalty of pedu~l~eja~ of th e State of Califom~ ~at the fore~ing is <br /> <br /> ~ut~ o~ At <br /> C~ ~ ~ATE SIG~ *~E OF OFFICEH~OER. ~ATE, ~ PRO~N1 <br /> <br /> Execul~ on ... Al By, <br /> DATE <br /> CI~ ~D STATE S~i URE OF OFFICEH~[ ER, ~DIDATE, OR PR~ENT <br /> <br /> <br />