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Recipient Committee <br />Campaign Statement <br />Cover Page <br />(Government Code Sections 84200-84216.5) <br />SEE INSTRUCTIONS ON REVERSE <br />Type or print in Ink. <br />Statement covers periodI Date of election if appl <br />from <br />July 1, 2011 (Month, Day, Year) <br />through September 24, 2011 I November 8, <br />1. Type of Recipient Committee: An committees -Complete Parts 1, 2,3,and4. <br />❑ Officeholder, Candidate Controlled Committee <br />® Primarily Formed Ballot Measure <br />Q State Candidate Election Committee <br />Committee <br />Q Recall <br />Q Controlled <br />(Also Complete Pans) <br />O Sponsored <br />❑ General Purpose Committee <br />(Also Compla(e Part6) <br />Q Sponsored <br />❑ Primarily Formed Candidate/ <br />Q Small Contributor Committee <br />Officeholder Committee <br />Q Political Party/Central Committee <br />(Also Complete Part]) <br />3. Committee Information <br />I.D. NUMBER <br />1340190 <br />Redwood City Residents to Protect City Services <br />STREET ADDRESS (NO P.O. BOX) <br />141 Wellsley Crescent <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />Redwood City CA 94062 <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />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 k <br />under penalty of perjury under the laws of the State of California that the foregoing is true and correct. <br />Executed on September 29, 2011 By <br />Date Stamp <br />able: - Paged of <br />SEP 2 9 2�i1 for Oficial Use <br />2. Type of Statement: <br />® Preelection Statement <br />❑ Semi-annual Statement <br />❑ Termination Statement <br />(Also file a Form 410 Termination) <br />❑ Amendment (Explain below) <br />CITY OF R IDVVOOD Ci <br />❑ <br />Quarterly Statement <br />❑ <br />Special Odd -Year Report <br />❑ <br />Supplemental Preelection <br />Statement - Attach Form 495 <br />Treasurer(s) <br />NAME OF TREASURER <br />Nancy Radcliffe <br />MAILING ADDRESS <br />141 Wellsley Crescent <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />Redwood City CA 94062 650-365-8486 <br />NAME OF ASSISTANT TREASURER, IF ANY <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX / E-MAIL ADDRESS <br />information contained hgteip and in the attached schedules is true and complete. I certify <br />Executed on September 29, 2011B \ 1 <br />Dale y SignalureofContmging Officeholder,Candidate, State MeasurePrep enlor Responsible OffirerofSponsor <br />Executed an By <br />Date Signature ofConirdling Ofiwho'der, Candidate, Slate Measure Pmponent <br />Executed on By <br />Date SignaWreofCon6olling Ofiwholtleq Cantlitlale,Stale Measure Pmponent FPPC Form 466 (January/05) <br />FPPC Tall -Free Helpline: 866/ASK-FPPC 1866/275.3772) <br />State of California <br />