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COVER PAGE - LONG FORM <br />Recipient Committee Date Stamp <br />Campaign Statement <br />(Government Code Sections 84200 - 84216.5) I ~ ~ [ I ~ [ Page 1of <br /> Statementcovempefiod Date of Election if applicabie: OCT :~ 3 Z003 A For Official Use Only <br /> <br /> fi'om 10/01/2003 (Mo~th, Day, YeaO <br /> CITY OF RECWOOD CiTY <br /> through 10/18/2003 03/02/2004 cFrY CLERK <br /> <br />1. Type of Recipient Committee: 2. Type of Statement: <br /> [] Officeholder, Candidate Controlled Committee [] Ballot Measure Committee [] Pre-election Statement [] Quarterly Statement <br /> ~ State Candidate Election Committee O Primarily Formed [] Semi-annual Statement [] Special Odd-Year Report <br /> O Recall O Controlled [] Termination Statement [] Supplemental Pre-election <br /> O Sponsored [] Amendment (Explain below) Statement - Attach Form 495 <br /> [] General Purpose Committee <br /> O Sponsored [] Primarily Formed Candidate <br /> O Small Contributor Committee Officeholder Committee <br /> O Political Party/Central Committee <br /> <br />3. Committee Information '.D. NUMSER Treasurer(s) <br /> 1252809 <br /> COMMITTEE NAME NAME OF TREASURER <br /> Ira Ruskin Democrat for Assembly Ash Pirayou <br /> STREET ADDRESS <br /> STREET ADDRESS (NO P.O. BOX) 125 S. Market Street, Suite 1160 <br /> 1001 Iris Street CITY STATE ZIPCODE AREACODE/PHONE <br /> <br /> CITY STATE ZIPCOOE AREACOOE/PHONE San Jose CA 95113 (408) 297-3795 <br /> Redwood City CA 94061 (650) 261-1410 NAMEOFASSISTANTTREASURER, IPANY <br /> <br /> STREET ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX <br /> STREET ADDRESS <br /> <br /> CITY STATE ZIP CODE AREA CODE/PHONE <br /> CITY STATE ZIP CODE AREA CODF~PHONE <br /> OPTIONAL: FAX/E-MAIL ADDRESS ( <br /> ( 650 ) 365 - 7210 / OPTIONAL: FAX/E-MAIL ADDRESS <br /> <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 c~ein and in the attached schedules <br />is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing i~ue.~ correct. <br /> Executed on r o( ~D~AT!~ ~ By ~ ~ ~EOF~ ~~ t~ / <br /> i / ~ / S[GNATJ~ )F/~REASUI~O A~J~A TREASURER) <br /> Executed on /~ /~-'--~/(:~..~ By ~ /~ % <br /> DAT/,E S GNATURE OF CONTROLLING OFFICEHOLDER, %DIDATE, S~TE MEASURE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR <br /> Executed on By <br /> DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT <br /> <br /> Executed on By <br /> DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT <br />S/CCW - PCAB0501380 (Rev. 9/99) State of California Fair Political Practices Commission. <br /> <br /> <br />