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COVER PAGE <br />�I Reci ient Committee Date Stamp�� <br /> p Type or print in ink. . � - . <br /> i Campaign Statement i �� �. ;�-�, � � • � <br /> .s -� �� � <br />� Cover Page r1 �r�l_, �,, \;�;i �� .- <br /> (Govemment Code Sections 84200-84216.5) <br /> Statement covers period Date of election if applicabl : I i /_ Q <br /> (Month, Day,Year) � OCT 2 3 Z003 ; age___L of—�— <br /> from � 03 For Official Use Only <br /> GITY OF HEuVVOGJ CITY <br /> SEE INSTRUCTIONS ON REVERSE � through D D 3 � �_ CITY CLERK <br /> 1. Type of Recipient Committee: nn comminees-comPiece rartg�,s,s,a�a a. 2. Type of Statement: <br /> �] Oficeholder,Candidate Controiled Committee ❑ Ballot Measure Committee ❑ Preelection Statement � Quarterly Statement <br /> �� Q State Candidate Eleclion Committee Q Primarily Fortned ❑ Semi-annual Statement � Special Odd-Year Report <br /> Q Recall Q Controlled ❑ Termination Statement � Supplemental Preelection <br /> (AlsoCOmpletePart5) Q Sponsored � Amendment(Explainbelow) Statement-AttachFortn495 <br /> ' (WSOCompletePart6) <br /> ❑ General Purpose Committee <br />� Q Sponsored ❑ Primarily Formed Candidate/ <br /> �Small ContributorCommittee Officeholder Committee <br /> Q PoliticalParty/CentralCommittee IA�soCompletePaR7) <br /> I.D. NUMBER Treasurer s <br /> 3. Committee Information q�j D7s� � ) <br /> COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> C v r►'1 m �ifie�e � E/e� D�+"b o-rci Pi c rc.�e l�.n�r�1 r � - �e-���o <br /> MAILING ADDRESS <br /> , .� <br /> STREET ADORESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE <br /> �,��woo�Q C�•�-y , C.n'- 9yc��a � <br /> CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, I ANY <br /> R.e�u�o � e�-Fu �Cj4- 4�l o !o t <br /> <br /> <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 <br /> certify under penalty of pery'ury under the laws of the State of Califomia that the foregoin true and c <br /> Exewted on�' �`�/� BY ` <br /> � D�le SignatureofTre rer Assistant7reawrer <br /> Ezecuted on •� a3��3 By <br /> D te Sgna[ureWContrd�ingOfficeholder,CaMitlale,StateMeasu2Pmponentor esponsibleOflicerofSponsor <br /> Executed on BY <br /> p�y SignaWre of Controlling ORkeholder,Candidale,Stale Measure Proponent <br /> Executed on BY FPPC Form 460(June/01) <br /> Dafe SignaWre W Controlli`g Ofikeholder,CarWidate.S1ate Measure ProO�rrt <br /> FPPC Toll-Free Helpline:S6WASK-PPPC <br /> State ot California <br />