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� COVERPAGE <br /> Recipient Committee rype or print In Ink. Date Stamp <br /> . Campaign Statement � ��� � • 1 <br /> CoverPage (� �p 2 <br /> . (Government Code Sedions 8420D-84216.5) D � �l9 � � V IS In�� 1 4 <br /> Statement eovers period Date of electlon if appllcable: Page of <br /> � 11-4-OS (Month, Day,Year) �qN 2 7 2009 U F°'orr�i� use oory <br /> from <br /> SEE INSTRUCTIONS ON REVERSE th�ough 12-31-08 CITY OCIN CL/ROD CI Y <br /> 7. Type of Recipient Committee: an commine�-comPi�e Pero�,s,s,aod a. 2. 7ype ot Statement: <br /> � ❑ Officeholder,Cantlidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statemenf � puarterly Statement <br /> QStateCandidateElectionCommitlee Committee ❑ Semi-annualStatement ❑ SpecialOdtl-YearReport <br /> Q Recall Q Controlled Termination Statement <br /> (AlsoCOmpbfePartS) S onsored � ❑ SupplementalPreelection <br /> � P (Also fle a Form 410 Termination) Statement-Attach Form 495 <br /> (Alm Complek Part6) <br /> � General Purpose Committee ❑ Amendment(Explain below) <br /> Q Sponsored � PrimarilyFormedCandidate/ <br /> QSmaIlContributorCOmmitlee OfficeholderCommittee <br /> QPoliticalParty/CentrelCommittee (asoComplelePart]) <br /> 3. Committee Information I.D. NUMBER Treasurer(s) <br /> 130639 <br /> COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> CITIZENS TO PROTECT REDWOOD CITY PLITICAL ACTION MARY MORTENSON <br /> COMMITTEE MAILING AO�RESS <br /> <br /> STREETADDRESS (NO P.O. BO%) CITV STATE ZIP CODE AREA CO�E/PHONE <br /> REDWOOD CITY CA 94064 <br /> CITV STATE ZIP CODE AREA COOE/PHONE NAME OF ASSISTANT TREASURER, IF ANV <br /> REDWOOD CITY CA 94064 <br /> MAILING ADDRE55(IF DIFFERENT� NO.AND STREET OR P.O. BOX MAILING AOORESS <br /> P.O. BOX 2163 • <br /> CITY STATE ZIP CODE AREA CODE/PHONE CITV STATE ZIP CODE AREA COOE/PHONE <br /> REDWOOD CITY CA 64064-2163 <br /> OPTIONAL; FAX/E-MAIL ADDRE55 OPTIONAL: FAX/E-MAIL ADDRESS <br /> 4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to lhe best of my knowled lhe info ation contained herein and in ihe atlached schedules is true and complete. I certity <br /> underpenaltyofperjuryunderthelawsoftheStateofCalifomiathattheforegoingistrueantic ec , <br /> Executed on��¢/9 By <br /> pab Si lu ofTreasurar rASaisteniTreasurer <br /> Ezecuted an � � '�r —�y By � <br /> � Sipr�eture fCOn B��holtlar,Cantlitlata,5�ataMeasurePmponeno ponsibleOffiwroi5poneo� <br /> Ekecuted on By <br /> Dab 518��olCOntloMlnB��hokeq CanEitleta,Stak Meawro Pmponent <br /> Executed on By <br /> oam SipnatunotCOntroMlnpOrfimnaltleqCaMitla�e,5tateMeasuroPmponam FPPCiorm480�January/05) <br /> FPPC Toll•Frae Helpline:B6filA5K-FPPC(8661275-3772) <br /> SWte of Californla <br />