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Recipient Committee T _ COVERPAGE <br /> Campaign Statement ype or print in ink. amp <br /> Cover Page RECE�v�� � ,.�, � ' • 1 <br /> (..''�overnment Code Sections 84200-84216.5) <br /> Statement covers period Date of election if applicabl �qN 2 5 2016 page � of 7 <br /> from <br /> October 18, 2015 (Month, Day, Year) <br /> City of Redwood Ci <br /> For fficial Use Only <br /> SEE INSTRUCTIONS ON REVERSE through <br /> December 31, 2015 2015 Election �;�y cieric <br /> 1. Type of Recipient Committee: All Committees—Compiete Parts 1,z,s,and 4. 2. Type of Statement: <br /> � Officeholder,Candidate Controlled Committee ❑ Ballot Measure Committee ❑ Preelection Statement � Quarterly Statement <br /> Q State Candidate Election Committee Q Primarily Formed � Semi-annual Statement � Special Odd-Year Report <br /> Q Recall Q Controlled Termination Statement <br /> (A/soCompletePaR5) � ❑ SupplementalPreelection <br /> Q Sponsored � Amendment(Explain below) Statement-Attach Form 495 <br /> (A/so Comp/ete Part 6) <br /> ❑ General Purpose Committee <br /> Q Sponsored � Primarily Formed Candidate! <br /> Q Small Contributor Committee Officeholder Committee <br /> Q Politicai Party/Centrai Committee (A/so Comp/ete Part 7) <br /> 3. Committee Information ��D. NUMBER Treasurer(s) <br /> 1374422 <br /> COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> Committee to Elect Janet Borgens for Redwood City Council 2015 Hollis Matheny <br /> MAILING ADDRESS <br /> <br /> STREET ADDRESS (NO P.O. BOX) CITY STATE 21P CODE AREA CODElPHONE <br /> Union City Ca 94587 ( <br /> CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY <br /> Redwood City Ca 94063 ( <br /> MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS <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 inf mation contained herein and in the attached schedules is true and complete. I <br /> certify under penalty of perjury under the laws of the State of California that the foregoin�''is true and correct. x <br /> . � , ,� <br /> . . -� 1 _���..+�^y <br /> d �af y....... f ___ ,/ <br /> Executed on �r �, -�� � �,, gy �` l,, ,'J.f � .,. y' ..''��c../>.�r„.__... <br /> �.�-��..-�"�� <br /> � Da(� ,� Signatureof���reasurerorAssistantTreasurer <br /> t ;� . . ! .... r <br /> Executed on BY '`r- .` " ` ,- ;, `t._--_ � � ,. ,;<.1'. <br /> Date Bignature of Controlhng Officeholder,Candidate,State MQasure Proponent or Responsible Officer of Sponsor <br /> 4` <br /> Executed on By ~ <br /> Date Signature of Controlling Officeholder,Candidate,State Measure Proponent <br /> Executed on BY FPPC Form 460 June/01 <br /> Date Signature of Controlling Officeholder,Candidate,State Measure Proponent � ) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC <br /> State of California <br />