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I <br /> <br /> This form must be used to amend statements filed pursuant to Government <br /> and must be filed with all filincj officers who j <br /> race ved the statement being amended. NOTE: This form ~s not used to <br /> amend a Statement of Organization (Form 410). To amend a Statement of C Y <br /> Organization, use the Form 410. CITY CL,ERK <br /> <br />FORM 405 <br />1989 (Type or Print in Ink) <br /> FOR OFFICIAL USE ONLY <br /> A <br /> I. The information required in Section I must correspond to the information provided <br /> on the campaign statement. <br /> <br />NAME OF FILER: I.D. NO (IF APPLICABLE): <br /> <br />ADDRESS OF FILER: NO. AND STRE ET CITY STATE ZIP CODE AREA CODE/PHONE NUMB E R <br /> <br />NAME OF TRE~URER (IF APPLICABLE): <br /> <br /> PERMANENT ADDRESS OF TREASURE R (IF APPLICABLE): NO. AND STREET CITY STATE ZIP CODE AREA CODEIPHONE NUMBER <br /> <br /> II. The following information amends campaign disclosure statement, Form No.__4..~, Executed on <br /> j~L~for the period through <br /> (MO., DAY, YR.) <br /> <br /> IlL The amended information affects items on the: <br /> [] Front Page [] Allocation Page ~Summary I--~Schedule(s) <br /> <br /> IV. Describe the changes below, include in detail all information you wish to become a part of your official campaign <br /> statement. Also attach a new front page, summary or appropriate schedule if needed for clarification. <br /> <br /> include additional information on reverse side or on appropriately labeled continuation sheets. (Number of pages at~ached ) <br /> VERIFICATION <br /> I HAVE USED ALL REASONABLE DILIGENCE IN PREPARING THIS STATEMENT. t HAVE REVIEWED THE STATEMENT AND TO THE BEST OF <br /> MY KNOWLEDGE THE iNFORMATION CONTAINED HEREIN AND IN THE ATTACHED SCHEDULE5 IS TRUE AND COMPLETE. <br /> I CERTIFY UNDER pq/4ALT/Y OF PERJUB.~UNDER THE LAWS~THE~ SAT~L~ OF CA~-~RN~A~ TH~AT THE FC~RF~OI~r~EIUE AND~ CORRECT <br /> EXECUTEDON ~I~II~AT ~m~l -IL~'~j ~'~I~'Y /~'~/'~'/~'~'~ ~' ~ <br /> A CANDIDATE, OFFICEHOLDER OR ~TATE MEASURE PROPONENT WHO CONTROL~ A COMMITTEE MUST ALSO VERI~Y THE <br /> ~MPAIGN STATEMENT. <br /> I HAVE USED ALL REASONABLE DILIGENCE. AND TO THE BEST OF MY KNOWLEDGE, THE TREASURER HAS USED ALL REASONABLE <br /> DILIGENCE IN PREPARING THI~ STATEMENT. I HAVE REVIEWED THE STATEMENT AND TO THE BE~T OF MY KNOWLEDGE T~E <br /> ,NFORMATIONCO"TAINEDHE~EtN AND INTHE ATTACHED SCHEDULES IS TRUE AND COMPLETE ~~N <br /> C I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALl HE <br /> <br /> ' D EXECUTED ON I · <br /> F EXECUTEDON AT <br /> <br /> <br />