Laserfiche WebLink
,' AMENDMENT TO CAMPAIGN DISCLOSURE STATEMENT [~ [~ ~ ~] ~/ [~,~, <br /> Th $ form must be used to amend statements filed pursuant to Government <br /> Code Sections 84200-84217, and must be filed with all filin~ officers who <br /> received the statement being amended. NOTE: This form is not used to <br /> amend a Statement of Organization (Form 410). To amend a Statement of <br /> Organization, use the Form 410. CITY OF REDWOOD QTY <br /> l CITY CLERK <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: t.O. NO (IF APPLICABLE): <br /> <br />ADDRESS OF FILER: NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE NUMBER <br /> · <br /> <br />NAME OF TREASURER (IF APPLICABLE): <br />PERMANENT ADDRESS OF TREASURE R (IF APPLICABLE): ND. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE tau M BE R <br /> <br /> II. The following information amends campaign disclosure statement, Form No. <br /> Executed <br /> on <br /> <br /> I~l~ .~d~ for the period ~ through <br /> {MO.. DAY. YR.) <br /> <br /> III. The amended information affects items on the: <br /> [] Front Page [] Allocation Page ~[]Summary []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 labeted continuation sheets. (Number of pages attached ) <br /> <br /> VERIFICATION <br /> I HAVE USED ALL REASONABLE DILIGENCE IN PREPARING THIS STATEMENT. I HAVE REVIEWED THE STATEMENT AND TO THE BEST OF <br /> MY KNOWLEDGE THE INFORMATION CONTAINED HEREIN AND IN THE ATTACHED SCHEDULES IS TRUE AND COMPLETE. <br /> I CERTIFY UNDER ~EN~TY OF PERJURYdII~DER THE LAWS ~THE,S~Ii~T_E OF ~.Jd~F.(~NIA 3'HAT~'JE/FO~EG~ING IS'T~U~ AND CORRECT <br /> EXECUTED <br /> ON <br /> AT <br /> <br /> INFORMATION CONTAINED HEREIN AND IN THE ATTACHED SCHEDULES IS TRUE AN~PLETE. <br /> c <br /> I CERTIFY UNDER P,NA~Y OF 'P~RJuRy~oER THE LAWS OF THE S~TE OF ~TH~H~ /S TRUE AND <br /> <br /> ' D EXECUTED ON--AT ........ ~ BY w <br /> <br /> F EXECUTED ON AT, BY <br /> <br /> <br />