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COVER PAGE <br /> omm <br /> p Type or print in ink. <br /> Recipient Committee - . a e'' amp <br /> Campaign Statement CALIFORNIA 60 <br /> Cover Page RECEIVED FORM <br /> NIA <br /> (Government Code Sections 84200.-84216.5) 1 7 <br /> Statement covers period Date of election if applicableJAN 2 f v J 2313 Page of <br /> 7/1/12 (Month, Dry, Year) For Official Use Only <br /> from <br /> CITY C F REDWOOD CITY <br /> SEE INSTRUCTIONS ON REVERSE through 12/31/12 ;,1TY CLERK <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 /> O State Candidate Election Committee Committee ® Semi-annual Statement ❑ Special Odd-Year Report <br /> Q Recall 0 Controlled Termination Statement <br /> (Also Complete Part 5) Sponsored ❑ ❑ Supplemental Statement tack Form� P (Also file a Form 410 Termination) Statement-Attach Form 495 <br /> (Also Complete Part 6) <br /> ❑ General Purpose Committee ❑ Amendment(Explain below) <br /> Q Sponsored ❑ Primarily Formed Candidate/ <br /> O Small Contributor Committee Officeholder Committee <br /> O 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 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 /> REWOOD 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 knowledge the information contained herein and in the attached schedules is true and complete. I certify <br /> under penalty of perjury under the I- of the State of California that the foregoing is true and correct. <br /> Executed on �--` By 1 / <br /> 'S•: Signature o reasurer <br /> 9 F 47 <br /> Executed on �� �� By � � Q� <br /> Signature of .••.7i.rOfficeholder,Candid. tp F re P•ponent or Responsible Officer of Sponsor <br /> Executed on By <br /> Date Signature ofControRng Officeholder,Can.'.- :,State Measure Proponent <br /> Executed on By <br /> Date Signature olControllng Ottkiehokler,Candidate,State Measure Proponent FPPC Form 460(Jarluary105) <br /> FPPC Toll-Free Helpline:8661ASK-FPPC(86612753772) <br /> State of California <br />