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COVER PAGE <br />Recipient Committee Type or print in ink. Date Stamp <br />Campaign Statement <br />Cover Page <br />(Government Code Sections 84200-84216.5) <br /> Stater~ent covers period Date of election if applicable: <br /> /_..-/...~O~..~, (Month, Day, Year) OCT I 0 200Z <br /> from <br /> For Official Use Only <br /> <br /> CiTY CLERK <br />1. Type of Recipient Committee: N~ Commlflees- Complete Pa~ 1, 2, 3, and 4. 2. Type of Statement: <br /> ~ Officeholder, Candidate Controlled Commiffee ~ Ballot Measure CommiEee ~' Preele~on S~tement ~ Qua~edy Statement <br /> ~ State Candidate Ele~ion Commiffee '~ D~marily Formed ~ Semi-annual Statement ~ Special Odd-Year Repeal <br /> ~ Recall ~ ~n~olled ~ Te~ination Statement <br /> ~lso Comp~te Pa~ 5) ~ Sponsored ~ Supplemental Preelection <br /> <br /> (Also~mpletePe~6) ~ Amendment (Explain below) Statement - A~ach Fo~ 495 <br /> ~~GeneraIsponsoredPU~°se CommiEee ~' Primarily Fo~ed Candidate/ <br /> ~ Small Contributor Committee ~ ~holder Commiffee <br /> O Politi~l Pa~y/Cen~al Committee (A/so ~mplete Pad 7) <br /> <br />3. Committee Information <br /> Treasurer(s) <br /> COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF~EASURER <br /> <br /> MAILING ADDRESS <br /> CITY. ~ ~ ~ V STATE ZIP CODE AREA CODE/PHONE <br /> <br /> CII~ . ZIP CODE NAME ~F ASSISTANT ~EASURER,~IF ANY ~ __ <br /> M~~~I~]~LIN~ ADDRESS (IF DIFFEREN~ NO. AND STREET OR P.O. BOX ~AILINGjggADDRES~. <br /> <br />4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowle.~jg.e the information contained herein and in the attached schedules is true and complete. I <br /> certify under penalty of perjury under the laws of the State of California that the foregoing is true and <br /> <br /> Executed on /o.- <br /> Executed o. /0 -- ?'~} ~"~' /~I1' S.'a~re Of Treasurer Or Assistent Treasurer <br /> Executed on By <br /> Date Signatu~f Controlling Ofliceho~ler, Candidate, State Measure Proponent <br /> <br /> Executed on By <br /> · Date Signature of Con'a'otling Officeholder, Candidate, State Measure P~t FPPC Form 460 (J une/01) <br /> FPPC Toll-Free Helpline: 8661ASK-FPPC <br /> State of California <br /> <br /> <br />