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Officeholder. Candidate, Typ. or Pdn, In Ink. $,&lernenl coven pitied <br />and Controlled Committee <br />Campaign Statement--Long Form "~ <br />(Govc~em C~ S~s 842~-~216.5) <br />SEE I~TRUCTIONS ON REVERSE Ih~qh, <br /> <br /> C .k .. ., ,.,,..,. ,. .-,*-, =-..-- 7 * <br /> ~ ~pp~nt~ Pro-oI~I~ Slalom~l (Alla~ a ~ploled F~m 495 lo Ibis stalest ) IMonl~ Day, Yoarl ~ L <br /> ,~ ~mi-a~ual Slal~nl ~/~ <br /> ~ Term~al~ Stal~nl (Nlach a c~p~ ~rm 415 lo this slal~nl.) <br /> <br />I Oflice~l~r, Cln~lle, II Other Co--trees Not I~luded in this Statemnt: Lat ~y other <br />a~ Controlled Co~ttee c~tees ~l i~l~ed ~ Ik~ c~oiMated sf~e~ t~ ~e c~rolled ~ you a~ ~y <br />I~l~ed in this S~te~nt c~lees of w~ck ~. ~ ~ledge I~t ~e pri~i~ /~d to receive c~ributio~ or <br />~ ~ ~n ~ C~IE: to ~ ~e~iture~ on ~~ur c~ida~. <br /> <br /> ~F~ ~ ~ ~: ~ L~AI~ ~ ~T~I ~R F <br /> <br /> ~NT~ ~ ~ ~ (~ ~ST~) ~ ~ I~R: <br /> ~TY STATE Z~ ~ ~ ~ ~ C~TIEE ~: (~ ~ SI~) <br /> ~E ~: ; I O ~R CiTY STATE Z~ ~ ~ C~IM[ Pl~[ <br /> <br /> C~EE ~E~ (~ ~Sl~) <br /> OTY TE Z~ ~ ~ ~ ~ ~ ~ T~R: C~i~O C~EE? <br /> ~ ~ T~R: 1 ~ ~ C~EE ~: <br /> <br />Il Verification Officeholder of Candidate: <br />Tr#mxof: I have used all reasonable diliBcncc and Io thc ~ of my knowledge ti~ t~casurcr has <br />i have used ali reasonable dililtencc in Ixcpa~nlt this statement and to thc hcst cE my used all rcas~lc diliBonce in ixcParin8 Ibis stalcmont. ! have reviewed thc state- <br />knowlcdgc thc information contained herein and in thc allachcd schedules is true and incfli and to thc hcst of my knowledge ~ information contained herein and in thc <br />complcte.! ccnify under penalty of perjury under Ibc laws of Ihc Slate of California ailachcd schedules is line and complete. I certify under penalty of perjury under thc <br />that thc fo~cgoing i~ linc and correcL laws of thc State of California thai thc forcgoing is true and correct. <br /> <br /> SIG~ATUFIE O~ TREASURE'--R ,~ v - -- '~,~[~NAqrugtE O¢ o~'iCL~F~0L~R-OR'CANOIDATE <br /> <br /> ~Ofl INFORMAIIOt, I REQUIRED 10 I~£ PflOVIDLD IO YOU Pt~qSUANI TO ltl£ INFORMATION PflACIICFS ACT OF 1977. SE£ INFORMA~IVL~UALON ~P^IG~J DISCLOSURE PflOVISIOI'~,~O[J[IF [~LIII~.,~L <br /> Sial® ol C&lllomla Fair Polillcal Pr&clicem Commission. <br /> <br /> <br />