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i <br /> Recipient Committee COVER PAGE <br /> Type or print in ink. Date Stamp CALIFORNIA 460 <br /> Campaign Statement <br /> Cover Page FORM <br /> (Government Code Sections 84200-84216.5) . <br /> Statement covers period Date of election if applicable: L . ' Page 1 of 4 <br /> from <br /> 7/1/2008 (Month, Day,Year) _ , For Official Use Only <br /> t . <br /> SEE INSTRUCTIONS ON REVERSE through <br /> 12/31/2008 11/3/2009 °. <br /> 1. Type of Recipient Committee: All Committees—Complete Parts 1,2,3,and 4. 2. Type of Statement: <br /> ® Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ® Preelection Statement ❑ Quarterly Statement <br /> Q State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report <br /> Q Recall 0 Controlled <br /> (Also Complete PM 5) Sponsored ❑ Termination Statement ❑ Supplemental Preelection <br /> p (Also file a Form 410 Termination) Statement-Attach Form 495 <br /> (Also Complete PM 6) <br /> ❑ General Purpose Committee ❑ Amendment(Explain below) <br /> Q Sponsored ❑ Primarily Formed Candidate/ <br /> Q Small Contributor Committee Officeholder Committee <br /> Q Political Party/Central Committee (Also Complete Part 7) <br /> 3. Committee Information I.D. NUMBER Treasurer(s) <br /> 1313963 <br /> COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> JOHN SEYBERT FOR CITY COUNCIL RICHARD S. CLAIRE <br /> MAILING ADDRESS <br /> SAME <br /> STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE <br /> <br /> CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY <br /> REDWOOD CITY CA 94062 <br /> MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O.BOX MAILING ADDRESS <br /> CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE <br /> OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS <br /> 4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledg the• formation contained herein and in the attached schedules is true and complete. I certify <br /> under penalty of perjury under the laws of the State of California that the foregoing is true and <br /> Executed on //21/29 By / Of - A <br /> Date Signatu=1 Treasu if'orAss; _ - <br /> Executed on I/LAV° By - ig <br /> ∎! ` ' A 4 <br /> Date - .=of Conte ng Officeholder,Candi.,iio,State =as f'=Pro. nent or Responsible Officer of Sponsor <br /> Executed on By <br /> Date Signature of Controlling Officeholder,Candidate,State Measure Proponent <br /> Executed on By <br /> Date Signature of Controling Officeholder,Candidate,State Measure Proponent FPPC Form 460(January/05) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) <br /> State of California <br />