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Recipient Committee <br /> Campaign Statement <br /> Cover Page <br /> (Government Code Sections 84200-84216.5) <br /> Type or print in <br /> Statement covers period <br /> from 7/1/04 <br /> SEE INSTRUCTIONS ON REVERSE I through 12�31/04 <br /> 1. Type of Recipient Committee: All Committees—Complete Parts 1,z,s,and 4. <br /> � Officeholder,Candidate Controlled Committee ❑ Ballot Measure Committee <br /> Q State Candidate Election Committee � Primarily Formed <br /> Q Recall Q Controlled <br /> (A/soCompletePartS) Q Sponsored <br /> (A/so Complete Part 6) <br /> ❑ General Purpose Committee <br /> Q Sponsored � Primarily Formed Candidate/ <br /> Q Small Contributor Committee Officeholder Committee <br /> 0 Political Party/Central Committee (AlsoCompletePaR7) <br /> 3. Committee Information �.D. NUMBER <br /> 1255762 <br /> COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br /> Committee to Elect lan Bain <br /> STREET ADDRESS(NO P.O. BOX) <br /> <br /> C�TY STATE ZIP CODE AREA CODE/PHONE <br /> Redwood City CA 94063 <br /> MAILING ADDRESS (IF DIFFERENT)N0.AND STREET OR P.O. BOX <br /> CITY STATE ZIP CODE AREA CODE/PHONE <br /> Date Stamp <br /> FEB 0 8 2005 <br /> J�I <br /> 11/4/03 <br /> 2. Type of Statement: <br /> ❑ Preelection Statement <br /> � Semi-annual Statement <br /> ❑ Termination Statement <br /> ❑ Amendment(Explain below) <br /> Treasurer(s) <br /> NAME OFTREASURER <br /> COVER PAGE <br /> Page 1 of$ <br /> For Official Use Only <br /> ❑ Quarterly Statement <br /> ❑ Special Odd-Year Report <br /> ❑ Supplemental Preelection <br /> Statement-Attach Form 495 <br /> Nancy Bain <br /> MAILING ADDRESS <br /> <br /> CITY STATE ZIP CODE AREA CODE/PHONE <br /> Redwood City CA 94063 <br /> NAME OF ASSISTANT TREASURER, IF ANY <br /> MAILING ADDRESS <br /> CITY STATE ZIP CODE AREA CODElPHONE <br /> OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX /E-MAIL ADDRESS <br /> ian C�ianbain.com <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 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 foregoing is true�pc�correct. � � <br /> Executed on 1/30/05 <br /> Oate <br /> Executed on 1/30/05 <br /> Date <br /> Executed on <br /> Date <br /> By <br /> By <br /> By <br /> Signature MConVolling Officehdder,Candidate,State Measure Proponent <br /> Executed on BY FPPC Fortn 460 June/01 <br /> Date Signature of Controlling Officehdder,Candidate,State Measure Proponent ( � <br /> FPPC Toll-Free Helpline:866/ASK-FPPC <br /> State of California <br />