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Reci ientCommittee COVER <br /> PACE <br /> P Type or print in ink. Date Stamp <br /> Campaign Statement CALIFORNIA 460 <br /> Cover Page FORM <br /> (Government Code Sections 84200-84216.5) page '4 1 of 6 <br /> Statement covers period Date of election if applicable: ,JUL 3 0 2012 <br /> 1/1/12 (Month, Day,Year) @ For Official Use Only <br /> from F ) <br /> SEE INSTRUCTIONS ON REVERSE through 6/30/12 y <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 El Quarterly Statement <br /> Q State Candidate Election Committee Committee Semi-annual Statement ❑ Special Odd-Year Report <br /> Q Recall 0 Controlled ❑ Termination Statement El Supplemental Preelection <br /> (Also Complete Part 5) 0 Sponsored (Also file a Form 410 Termination) Statement-Attach Form 495 <br /> (Also Complete Part 6) <br /> ❑ General Purpose Committee El 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 1313693 Treasurer(s) <br /> COMMITTEE NAME(OR CANDIDATES NAME IF NO COMMITTEE) NAME OF TREASURER <br /> JOHN SEBERT FOR CITY COUNCIL 2009 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 I 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 m owledge the information contained herein and in the attached schedules is true and complete. I certify <br /> under penalty of perju7/1;;Z/12"--de a laws of the State of California that the foregoing is true and co � L <br /> B 4 < . At <br /> Executed on Date By Signature f' r <br /> 7 ' _ , <br /> Executed on / By t 1 , MITI <br /> Date Signature of Controlling Officeholder,Candidate,-',teM-=-u ill'i tar 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 Controlling Officeholder,Candidate,State Measure Proponent <br /> FPPC Form 460(January/05) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) <br /> State of California <br />