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COVER PAGE <br /> Recipient Committee Type or print In Ink, Data Stamp <br /> Campaign Statement <br /> Cover Page <br /> (Government Code Sections 84200-84216.5) <br /> Statement covers period Date of election if applicable: <br /> from /b~h/--i~) / (Month, Day, Year) Page / of b, <br /> For Official Use Only <br /> <br /> SEE ,NSTRUCTIONS ON REVERSE through /~-3 <br /> <br /> 1. Type of Recipient Committee: A, Committees -Complete Parts 1, 2, 3, and 4. 2. Type of Statement: <br />  Officeholder, Candidate Controlled Committee Ballot Measure Committee [] Preelecfion Statement <br /> Quarterly <br /> Statement <br /> O State Candidate Election Committee O Primarily Formed .~ Semi-annual Statement [] Special Odd-Year Report <br /> O Recall O Controlled [] Termination Statement [] Supplemental Preelection <br /> (A/so Corollate Part 5) O Sponsored <br /> (Also Complete Part 6) [] Amendment (Explain below) Statement ~ Attach Form 495 <br /> ) General Purpose Comm~ee <br /> O Sponsored [] Primarily Formed Candidate/ <br /> O Small Contributor Committee Officeholder Committee <br /> O Political Party/Central Committee ~ complete Part 7) <br /> <br /> 3. Committeelnformation II'D'NUMBER /,~¢~)~ Treasurer(s) <br /> COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME ~(~T. REASU, I~ER . <br /> <br /> STREET ADDRESS (NO P.O. ~ CITY b STATE ZiP CODE <br /> <br />'-~ CI~ ~J ~ O~ ~L~ ~ STATE q~;bc~DE ~ ~ ~/~ NA~ ~t~SISTANT TREASU RL=~, IF ANY <br /> MAILING ADDRESS (iF DIFFERENT) NO. AND STREET OR Re. BOX MAILING ADDRESS <br /> <br /> CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE <br /> OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS <br /> <br /> Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowle.~p~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 and cor~ct~. !~ <br /> Executedon 01- t); .y /V, , ./1/l l l'Z-',,i , <br /> -- -- -- i Treasurer or Assistant Treasurer <br /> Executedon bi-- ~OC" 0~1-'0' By <br /> <br /> IV',, / <br /> on By ~ "- <br /> Executed <br /> Date ~ S~m &f ~ti~ Offi~ho~, Candidate, State Measure P~ne~ <br /> Executed on By <br /> Date S~nature of C~ling Off~h~der, ~idate, State Measure P~ent FPPC Form 460 (June/01) <br /> FPPC Toll-Free Helpline: 866/ASK-FPPC <br /> State of California <br /> <br /> <br />