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= R�cipientCommittee coveRPnce <br /> Campaign Statement Type or print in ink. Oate Stamp • ' <br /> • ' . <br /> Cover Page '" :�' '� � "° � " ' <br /> (Govemment Code Sections 84200-84216.5) � �;j ;� �I ��d! iC i} � - <br /> IIStatement oovers period Date of election it applicabl R g U <br /> .� � C � (Month, Day,Year) Jry� d � Za03 Page_� of� <br /> from <br /> For Offcial Use Only <br /> Ci7Y OF RE�74`lOOD CI7Y <br /> SEE INSTRUCTIONS ON REVERSE through '� �3� p °��-' C�i-`CLERK <br /> 1. Type of Recipient Committee: ai comm�nae:-comP�eee Pa,u�,�,a,a�a a. 2. Type of Statement: <br /> � � �] Officeholder,Candidate CoNrolled Commitlee ❑ Ballol Measure Commitlee ❑ Preeleclion Statemenf � puartedy SWtement <br /> Q S�ale Candidale Election Commillee Q Primarily Formed �Semi-annual Slatemenl � Special Odd-Year RepoA <br /> Q Recall Q Controlled <br /> (asoco��reiaPens� ❑ TerminationSlatement � SupplementalPreeleclion <br /> Q Sponsored � pmendment(Explain below) Slalement-Altach Form 495 � <br /> (aso co,rore�e vart s� <br /> ❑ GeneralPurposeCommitlee . <br /> Q Sponsored ❑ PrimarilyFOrmedCandidale/ <br /> QSmallConVibulorCommillee OfficeholderCommittee <br /> Q PoliticalParty/CeMralCommiltee (a.,oc�rereran�l <br /> 3. Committee Information �.D. NUMBER Treasurer(s) <br /> D 7 SU <br /> COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> /� � i c.�.¢-,-� l��/� �5 ���_�f c Y <br /> Co�zt n2 i �2-� � ���' C� f/�CW��G�'G..� �i �1rC_� MnwNC no�aess <br /> <br /> STREET ADORESS (NO P.O. BOX) CIT STATE ZIP CODE AREA CODE/PHONE <br /> /� �� ��'� w�vcQ ��'`�z� C�� ��OG� � <br /> qT STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, 19 NV <br /> ��e� �o o c�.L'i� � L'R �iya�l �; ., re ��� �. � �p l�'_� �-/�� � <br /> MAILING ADDRESS (IF DIFFERENT NO.AND STREET OR P.O. BO% MAILING AOORESS <br /> <br /> CITV STATE ZIP CODE AREA CODE/PHONE CI V Q.,S�TATE�''` ZIP CODE AREA CODE/PHONE� <br /> <br /> OPTIONAL: FAX/E-MAIL ADORE <br /> 4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best oF my knowledge Ihe information contained herein and in the attached schedules is true and complete. 1 <br /> certity under penalty o(perjury under Ihe laws of the S�ate of Califomia lhal the foreg g is tme and c rec� <br /> Exewiea on� b gy <br /> Da1e SignaW o r urerarASSwlanlTreasurer <br /> Executed on By - <br /> Oale Sig ureWCOnVdlingORCWidder, nGidd�¢,SWIeMeasureP ResponsideORCero�Sponsa <br /> Execu�ed on By <br /> Dale SignaWreolCmVaS�irgOffrz�dda,CarqiOale,SlaleMeasuraPmponent <br /> Exewletl on By FPPC Form 460 Junel07 <br /> Da�e SignalureolConVdlingOff�dder,CaMitlate,SW�eMeasurePmponen� ( � <br /> FPPC 7oll-Free Helpline:B6WASK-FPPC <br /> Stale of Californla <br />