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COVERPAGE <br /> Recipient Committee <br /> Type or print in ink. ^ate,Stamp <br /> Campaign Statement �,_ • " ' . , � <br /> CoverPage � ���,,� ���;� ' � <br /> (Govemment Code Sections 8420D-84216.5) �; <br /> Statement covers period Date af election if applicable: � ,,:, Page� of <br /> trom <br /> 9/25/11 (Month, Day,Year) 0�T 2i U ��� For otrciai use oniy <br /> i <br /> SEE INSTRUCTIONS ON REVERSE through ���22��� ���8��� C:f Y OF REC`.^!CG �C!7Y <br /> � CITYCLERK <br /> 1. Type of Recipient Committee: nn comm�neaa-comPieeo ea��,z,a,e�a s. 2. Type of SWtement: <br /> � O�ceholder,Candidate Controlled Committee ❑ Primarily Pormed Ballot Measure ❑ Preelection Statement � puartedy Statement <br /> Q State Candidate Election Committee Committee ❑ Semi-annual Statement � Special Odd-Year Report <br /> � Recall Q Controlled � Termination Shatement Su lemental Preeleclion <br /> (A�soCwnplefePaNSJ Q Sponsored (AlsofileaForm410Termination) ❑ Statement-AttachFottn495 <br /> (AlmCwnplelePartfi) <br /> ❑ General Purpose Committee ❑ Amentlment(Explain below) <br /> Q Sponsored � Primanly Formed Candidate/ <br /> �SmallContributorCommittee �fficeholderCommiriee <br /> QPoliticalParry/CentralCommittee �A���mO�efePatl]J <br /> 3. Committee Information I.D. NUMBER Treasurer(s) <br /> 1255762 <br /> COMMITtEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> lan Bain for City Council 2011 Lorianna Kastrop <br /> MAILlNG ADORE55 <br /> 28 Meadow Lane <br /> STREET ADORESS (NO P.O. BOX) CITV STATE ZIP CODE AREA CODE/PHONE <br /> Redwood City CA 94063 <br /> GTV STA7E ZIP CODE AftEA CODEIPHONE � NAME OF ASSISTANT TREASURER, IF ANY <br /> Redwood City CA 94061 <br /> MAILING ADDRE55(IF DIFFERENT) NO.ANO STREET OR P.O. 80X MAILING AOORE55 <br /> CITY STATE 21P COOE AREA CO�E/PHONE CITV STATE ZIP CODE AREA COOE/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 information contained herein and in the attached schedules is true and complete. I ceAify <br /> under penalty of perjury under the laws of the SNate of California that the foregoing is true and correct. <br /> Ececutetl on ���27��� By <br /> �� � SI9naNr 1 reasurer AssisbntTreasurer <br /> e:ecuted on 10/27/11 ey � <br /> �� . SigraWreofCOntrdlingOifice�oltleq MiCat¢,StateMwsureProponeMaRespw�sibleOlficerofSponaor <br /> Executee on ' gy <br /> �ate SignaWreolCantrolliigqficehdtler,CaiWitlele,SbteMeasurePropaxnt � <br /> Ezecuted on gy � <br /> �ete SignaWreatCantrolY�ORice�dtler,GantlWale.S�ateMeasurePropment <br /> FPPC Fortn 6fi0(January/OS) <br /> FPPC Toll-Frae Helpline:B6fi/ASK-FPPC(866/275-7772) <br /> Shte of Califarnia <br />