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R � <br /> Recipient Committee T COVER PAGE <br /> ype or print in ink. � D�ate Stamp � �_ � , ' <br /> Campaign Statement ���� �_ • <br /> Cover Page � ; __ <br /> (Government Code Sections 84200-84216.5) °� ` ,�' �: Pa e 1 � 4 <br /> ' Statement covers period Date of election if ap licable: <br /> 1/1/15 (Month, Day, Ye r) J(�� c� �, �O'� , For Official Use Only <br /> from ; <br /> � <br /> SEE INSTRUCTIONS ON REVERSE through 6/30/15 �� r����,„�"�y�.C��p � <br /> �,., C/TY <br /> 1. Type of Recipient Committee: All Committees-Complete Parts 1,s,a,and 4. Z. Type of Statement: � <br /> � Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement � Qua ly Statement <br /> �State Candidate Election Committee Committee � Semi-annual Statement � Special Odd-Year Report <br /> � Recall Q Controlled Termination Statement <br /> (AlsoCanp/etePaR5) S nsored � ❑ SupplementalPreelection <br /> Q Po (Also file a Form 410 Termination) Statement-Attach Form 495 <br /> �a�o co,�aereaarts� <br /> ❑ General Purpose Committee ❑ Amendment(Explain below) <br /> Q Sponsored � Primarily Formed Candidate/ <br /> �Small Contributor Committee Officeholder Committee <br /> �Political PartylCentral Committee (A�o com�rererart�� <br /> 3. Committee Information �.D. NUMBER Treasurer(s) <br /> 1313963 <br /> COMMITTEE NAME(OR CANDIOATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> JOHN SEYBERT FOR CITY COUNCIL 2013 RICHARD S. CLAIRE <br /> MAILING ADDRESS <br /> SAME <br /> STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE <br /> <br /> CITY STATE ZIP CODE AREA CODElPHONE NAME OF ASSISTANT TREASURER, IF ANY <br /> REDWOOD CITY CA 94062 <br /> MA�LING ADDRESS (IF DIFFERENT) NO.AND STREET OR P.O. BOX MAILING ADDRESS <br /> CITY STATE Z�P CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE <br /> OPTIONAL: FAX!E-MAII ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS <br /> 4. Ve�cation <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best o e e the i mati contai ein and in the attached schedules is true and complete. I certify <br /> under penalty of perjury underthe laws ofthe State of California that the foregoing is true an e <br /> � <br /> 7/16/15 <br /> Executed on � By sipnatureofT reror ' mT r <br /> � Z7 � �� <br /> Executed on � By S etureoiCam , ndid . ProponentorResponsbleal'ceroiSpona« <br /> Executed on oate By Si�atureorControNngolFiceholder�Candidate,StateMeasureProporrent <br /> Executed on By <br /> Date Signature of ConUo�ng OH'wehdder,Cendidate,State Meeaure ProporreM <br /> FPPC Portn 480(January/08) <br /> FPPC Toll-Free HeIpIMe:886/ASK-FPPC(886/2T5-3772) <br /> State ot CaNtomla <br />