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<br />Officeholder, Candidate, <br />and Controlled Committee <br />Campaign Statement - Long Form <br />(Government Code Sections 84200-84216.5) <br />SEE INSTRUCTIONS ON REVERSE <br />Check one of the following boxes to Indicate the type of statement being filed: <br />B Pre-election Statement <br />Supplemental Pre-election Statement (Attach a completed Form 495 to this statement.) <br />. Special Odd-Year Campaign Report <br />Semi-annual Statement <br />Termination Statement (Attach. completed Form 41 S to this statement.) <br />.Ice 0 erl. an I ate, an antra e ommlttee <br />Included in tnis Statem.nt <br />NAME OF DFFICEHOLDER OR CANDIDATE <br />DI~ I-ktuÞcIl2.D . <br />OffICE SOUGHT OR HELD (lNCLUOE lOCATION AND DISTIUCT NUMlElllf ArPllCAIlE) <br />_Vt(!.¿ ~ÄYDwL- "Re~ (!tïV <br />RESIDENTIAL OR IUSINESS ADDRESS (NO. AND STREET) <br />% ~ <br />my STATE ZlPCOOE AREA COOEIDAYTIME PHONE <br />~ 94!>b2- ( <br /> <br />Type or print In ink. <br /> <br /> <br /> <br />1.0. NUMIEII <br /> <br />L- I q41 <br />I COMMmn ADOIIISS (NO. AND STREET) <br />~ ~ ~ <br />my STATE ZIP CODE AIIEA CODEIDA YT"UHONE <br />~ Œrf\l . r!A 9~¿ ~ <br />~ASURER <br />D 5. &Alr<ç:: <br />PERMANENT ADOIIESS Of TREASUIIIII ING. AND STIIIET) <br />~~ <br /> <br /> <br />my <br /> <br />STATE <br /> <br />lIP CODE <br /> <br />AIIEA CODEIDAYTIME PHONE <br /> <br />COVER PAGE - LONG FORM <br /> <br /> <br />Statement covers period <br />from. 7J¡ <br /> <br />Date Stamp <br /> <br />'age / of ~ <br />For Official Use Only <br /> <br />ffier Committees Not Includedìn this Statement: Ust any ot"'r <br />committees not Included in this consolidated statement fhlt are controlled by you and any <br />committees of which you hive knowledge that are primarily formed to receive contributions <br />or to make expenditures on behl" of your candidacy. <br />-..... I'D,""'" <br /> <br /> <br />NAME Of TIIIASUREII CONTROllED COMMmEU <br />DYES OND <br /> <br />cOMMmEE AOOIIESS <br /> <br />(NO. AND STIIIET) <br /> <br />CITY <br /> <br />STATE <br /> <br />ur CODE <br /> <br />AREA CODEIDAYTIME PHONE <br /> <br />cOMMmEE NAME 11.0. NUMIEII <br /> <br /> <br />NAME Of TREASUllEII CONTROllED cOMMmEU <br />0 YES P "10 <br /> <br />COMMmEE ADOIIESS <br /> <br />(NO. AND STIIIET) <br /> <br />\1 <br /> <br />CITY <br /> <br />STATE <br /> <br />urCODE <br /> <br />ARIA COOEIDAYTIME PHONE <br /> <br />ACtICh lddItlonallnformatlon on appropriately labeled continuation sheers. <br /> <br />III Verification <br />I have used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my kno~~)le th~nformation. contained herein and in the attached Khedules is <br />true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is ~ jOrre~/ . / /1 /. <br />Executedon \sl'!ool~~ . AtYI::Ð.~ 6rr-¡ &. By <br />DATE mv AND STATE <br /> <br />An officeholder or candidate who controls a committee must also verify the camp.lgn statement. I have used all reasonable diligence and to the best of my knowledge the treasurer has used all <br />reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained herein and in the attached Khedules is true and <br />complete. I certify under penalty of perjury under the laws. of the State of California that the foregoing is true a"VJrect.. ~,--ß <br /> <br />Executedon~J - 9(, At 1fE.X>iAJoc:n~ {J.J~ ÚA By ~- ' <br />DATE CITV AND ST -' SIGNATURE Of CANDIDATElOffICEHOlDEII' <br /> <br />Executed on At By <br /> <br />DATE <br /> <br />my AND STATE <br /> <br />Executed on <br /> <br />At <br /> <br />DATE <br /> <br />CITY AND STATE <br /> <br />fOR INfORMATION REQUIRED TO IE PIIOVIDED TO YOU PUIISUANT TO THE INfORMATION PllACTICESACT Of 1977. SEE INfORMATION MANUAL ON CAMPAIGN DISClOSURE PROVISIONS Of THE POLITICAL REfOIlM ACT <br /> <br />r"'--"'_II'___I_r.I_..-II.I--'" -"d "..__.'-.1_- <br /> <br /> <br />SIGNATURE Of CANDIDATEIOfflCEHOlDEII <br /> <br />By <br /> <br />SIGNATURE Of CANDIDATElOfflCEHOlDER <br />