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Officeholder, Candidate, ?ype o, print in ink. <br /> ~ COVER PAGE - LONG FORM <br /> <br />and Controlled Committee Statement cove~ ~r~ Date Stamp <br />Campaign Statement -- Long Form ~,~ <br /> <br />~ck ~ ~ t~ f~ing ~xes to i~k~te t~ ~ ~ stltement ~lng fi~: Date ~ e~ ~ ~ka~: For Official U~ Only <br />  Pre~le~ion Statement (~h, Day, Yea;) <br /> Supplemen~l Pre~l~n Statement (A~ach I completed Form 495 to this Katement.) <br /> S~cial ~d-Yeir ~m~ign Re~ <br /> <br />I Officeholder. Candidate, and Controlled Commi~ee II Other Committees Not Included in this Statement: ~,wo~r <br /> Included in this Statement c~m~ees~ti~l~lnt~c~t~lte~tarec~tr~l~y~a~ <br /> NAME OF ~F~EHO~ER ~ ~N~ATE . c~m~ees of <br /> <br /> I <br /> <br /> NAME OF TRE~ORER Cm~! A~IS ~. A~ ST~ <br /> <br />Ill <br /> verifiution <br /> <br /> r~a~on~bl~ dili{m~e in pr~rin{ thi~ .~t~m.nt. I h.v~ rmview~ thru .~t~m~nt and to th~ ~. of my kn~l~ th~ inlormation ~ontain~d h~r. in nnd in th~ a.a~h~ ~h~u{~ i{ tru~ ~nd <br /> tompl~t~. I ~m.i~ under ~n~ of ~quq under ih~ }~w~ of th~ {t~t~ of California that th~ <br /> <br /> ~ xecut~ on At By <br /> DATE C~V AND STATE SIGNATUnE Of ~NDIDATE~F~E~DER <br /> Executed on At By <br /> DATE CITY AND STATE SIGNATURE OF ~NOIDATE~FKE~DER <br /> <br /> Executed on At By <br /> DATE C~Y AND STATE S~NATURE OF CANDIDATE~F~E~Di~ <br /> <br /> FOrt INF~AT~ ~O lO BE P~OVIDiD TO Y~ PU~UA~ TO THE INFO~MAT~ P~ES A~ ~ ~g77, SEE INF~ATiON ~ANVA <br /> <br /> <br />