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COVER PAGE -- LONG FORM <br />Recipient Committee Type or Prinl in lnk. 1" ': ~ ' c-::::~&,~ OG~$mmp <br />CBm~ign Statement ~ Long Form <br /> <br />D Pre-~ti~ ~at~a ffi ~-mnual Stature If ~: <br />~ ~cial ~d-yea[ C~aign ~ 1~ ~y, Y~rl <br /> <br />D Sup~nlN p~t~ S~ (~ a ~leled Form 495 to this stal~nl.) I I- ~ - ~ ~ <br />~er~na~ ~at~ (Aaa~ a ~ Fmm 415 to ~= slant.) <br /> <br />I Committee Inlormltion II Primarily Formed Committee |he definilion on reverse.) <br />Ust names el officeholdorls) or clndiclateis) for which this <br />~o~coud.~: conunittee is prJmril¥ formed <br />j~:'Du, ooD C,I'~I <br />I <br />( Che.~ Boxes) $¢¢ definJtJon~ and ir, wormm i~ormmion on reverse. <br />Is tl~s a qmmored commiuee? .................................... [] <br />is Ibis a broad based polilical commil~ee? ................... [] Ye~ <br />Aua~a addalor, al ia/om~Uioa oa opprop, ia~ely labele~ co~i~m~ioa ~e,,,s. <br />II Verllicstlon / <br />I I~v~ ~d all ~so~blc diligc~ in <br /> <br /> <br />