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COVER PAGE - LONG FORM <br />Recipient Committee )~ (~ <br />Campaign Statement <br /> JAN 1 3 2O04 <br />(Government Code Sections 84200 - 84216.5) Page i of, 13 <br /> <br /> Statament covers pe~io4 Da~e of Election if; REDWOOD CITY A For Official Use Only <br /> CITY CLERK <br /> ~om 10/19/2003 (Mon~h, D~y, Yem) <br /> fhrou~h 12/31/2003 03/02/2004 <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 /> (~ Political Par[y/Central Committee <br /> <br />3. Committee Information '~°2~SU~E~ Treasurer(s) <br />COMMIttEE NAME NAME OF TREASURER <br />Ira Ruskin Democrat for Assembly Ash Pirayou <br /> STREET ADDRESS <br /> <br /> STREET ADDRESS (NO P.O. BOX) 125 S. Market Street, Suite 1160 <br /> <br /> 1001 Iris Street cra,' STATE ZIPCODE AREACODE/PHONE <br /> San Jose CA 95113 (408)297-3795 <br /> CITY STATE ZIP CODE AREA CODE/PHONE <br /> Redwood City CA 94061 (650) 261-1410 NAMEOFASSISTANTTREASURER, IFANY <br /> <br /> STREET ADDRESS (IF DIFFERENT) NO AND STREET OR P.O. BOX <br /> STREET ADDRESS <br /> <br /> CITY STATE ZIP CODE AREA CODE/PRONE <br /> CITY STATE ZIP COON AREA CODE/PHONE <br /> <br /> OPTIONAL: FAX/E-MAIL ADDRESS ( ) <br /> (650) 365-7210/ OPTIONAL: FA.XJE-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 containe~ h~'~ and in the at. chad schedules <br /> is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. <br /> <br /> ~ /DATE ~ ~ SlGi~'~J,T.b'~EOFTREASURE~P,J;;~(SSlSTANTTR~'-ASURE~ ' ~ I -/! - <br /> <br /> Executed on Byt,.__ -- ' /I <br /> / - / D,~TE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT OR RESPONSIBLE OFFICER OF SPON~IiI~)R <br /> <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 /> <br />S/CCW - PCAB05 01380 (Rev. 9/99) State of California Fair Political Practices Commission. <br /> <br /> <br />