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Recipient Committee COVER PAGE <br />Campaign Statement Type or print in ink. Date Stamp <br />Cover Page <br />(Government Code Sections 84200-84216.5) <br /> <br /> from ,/~"'"/--~'-'~ (Month, Day, Year) 1{} OCT ~ 8 Z00Z <br /> Page <br /> <br />SEE INSTRUCTIONS ON REVERSE through /~--/~~ ..... C,TY OF REC',,OCD C,TY <br /> CiTY CLERK <br />1. Type of Recipient Commiffee: ~ CommlUees - Complete Pads 1, 2, 3, and 4. 2. Type of Statement: <br /> ~ ~ceholder, Candidate Controlled Commi~ee ~ Ballot Measure C&mmiffee ~ Preele~ion Statement ~ Quadedy Statement <br /> O State Candidate Election ~mmi~ee O Primarily Foxed .~ Semi-annuaIStatement ~ Special Odd-Year Repo~ <br /> O Re~ll O controlled ~ Termination S~tement <br /> (m~o~p/e~ep.~5) O Sponsored ~ Supplemen~lPreele~ion <br /> (A/~ Co~/etePa~6) ~ Amendment (Explain below) Statement- AEach Fo~ 495 <br /> ~ GeneraIPu~ose Commiffee <br /> O Sponsored ~ Primarily Foxed Candidate/ <br /> O Small Con~ibutor Commi~ee Offi~holder Commi~ee <br /> O Politi~l Puny/Central Committee (A/so ~mplete Pe~ 7) <br /> <br />3. Committee Information Treasurer(s) <br /> COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME QF. TREASURER . . <br /> <br /> ~AILING ADDRESS (IF DIFFE D STREET OR P.O. BOX MAILING <br /> <br /> CITY STA~ ZIP CODE AREA CODE/PHONE T~] I / -- ~/ .STATE - ZIP CODE ~ AREA CODE/PHONE <br /> <br />4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowJetdge the information contained herein and in the attached schedules is true and complete. I <br /> certify under penalty of p~r~ry under the I§ws of the State of California that the foregoing is true and c~rrl~,I ~ 1 J <br /> <br /> ~ Date <br /> ~'/ ~"~'"-~'~ By / 71_~~°fTreasurer°~AssistantTreasurer <br /> 'Executed on Date By /'~1~ Signature ~f Cont~oiling Officeholder, Candidate, Stata Measure Proponent <br /> <br /> Executed on By <br /> Date Signature of Control#rig Officeholder, Candidate, State Measure Proponent FPPC Form 460 (J unel01 ) <br /> FPPC Toll-Free Helplina: 8661ASK-FPPC <br /> State of California <br /> <br /> <br />