Laserfiche WebLink
Recipient Committee <br /> Cam paign Statement Type or print in ink. COVER PAGE <br /> (Government Code Sections 84200-84216.5) <br /> <br />SEE INSTRUCTIONS ON REVERSE through C~T~' OF <br />SEE INSTRUCTIONS ON REVERSE throug~ CITY CLERK <br /> <br />l\T~ype of Recipient Committee: Ali Commlttees - Complete Parts l, 2,3, andl. 2. Type of St~ement: <br /> ,~Offlceholder, Candidate [] Primarily Formed Candidate/ [] Pre-election Statement <br /> / 'Controlled Committee Officeholder Committee [] Quarterly Statement <br /> [] S. emi-annual S~atement <br /> (Also Complete Part4.) (Also Complete PAX6.) ]~'ermination Statement [] Special Odd-Year Report <br /> [] Ballot Measure Committee [] General Purpose Committee [] Supplemental Pre-election <br /> O Primarily Formed O Sponsored [] Amendment (Explain below) Statement - Attach Form 495 <br /> · O Controlled O Broad Based <br /> O Sponsored <br /> (Also Complete Part 5.) <br /> <br />3. Committee Information <br /> COMMITTEE NAME Treasurer(s) <br /> NAME OF TREAS URE~ <br /> <br /> Cl~ <br /> <br /> ~LING~DRESS <br /> CI~ STA~ ZIP CODE ~ COD~H~E CI~ STA~ ZiP C~E AR~ COD~HONE <br /> OPTION~ F~/E-MAIL ADDEE~ O~IONAL: F~/E-MAIL <br /> <br /> FPPC Form 490 (8/99) <br /> For Technical Assistance: 9161322-5660 <br /> State of California <br /> <br /> <br />