Claire 07-01-1995 thru 12-31-1995 Semi-Annual 490

Browse Search

i 'Officeholder, Candidate, Ty. or print inink. COVER PAGE-LONG FORM and Controlled Committee Statement covers period Date Stamp Campaign Statement -- Long Form f,om [~ ~] ~ J~ (Government Code Sections 8~,200-84216.5) SEE INSTRUCTIONS ON REVERSE 1 of '~ Check one of the following boxes to indicate the type of statement being filed: Date of e~alon a, JAN 3 1 1996 [] Pre-election Statement (Month, Day, Year) For Official Use Only [] Supplemental Pre-election Statement (Attach a completed Form 495 to this statement.) Special Odd-Year Campaign Report Semi-annual Statement Termination Statement (Attach i completed Form 41S to this statement.) List any other Included in tis Statement committees nOt included in this consolidated statement that are controlled by you and any NAME OF OFFICEHOLDER OR CANDIDATE committees of whkh you have knowleo~le that are primarily formed to receive contributions r~ ~'r~ i ~,~.~ ~j~) ~ ~_~L.~ ) i~.~ ' Of' to make expenditures on hehelf of your candidacT. ~ COMMITTEE NAME I I.D. NUMBER OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) I RESIDENTIAL OR BUSINESS ADDRESS (NO. AND STP.~ET) NAME Ot: TREASURER CONTROLLED COMMITTEE? CITY /¢~TATE ZIP CODE AREA CODE/DAYTIME PHONE COMMIITEE ADDRESS (NO. AND STRELrI~ COMMITTEE NAME ! I"~D' K-UMBER CITY STATE ZIP CODE AREA CODE/DAYTIME i COMMITI'EE ADDRESS (NO. AND STREET) CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE NAME O~ TREASURER COI~I'ROLLED COMMIITEE? NAME OF TREASURER ' ' COMMnTEE ADDRESS (NO. AND STREET) PERMANEm ADDRESS Of TREASURER 000. AND STREET) CITY STATE ZIP CODE AREA CODE/DAYTIME CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE Attach additional lnformation on a/~oropriately labe/edcontinuation sheets. III Verification I have used ell reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained herein and in the attached schedules is i true and corn plete/. I ceqi~ under penalty of R~jury under the lavy~ of the State 9~ California that the foregoing is,~e/~d cot :e~. Executed on ~! "~01'~' ' At .~~ ~..L~ ~,~, By '~/ ~ ~/~Z~ r~/ An officeho ,kl.,e. r o~ candidate who c. ontrols a committee must also verify the campaign statement. I have used all reasonable diligence and to the bes~f my knowledge the treasurer has used all reasonable oiligence in preparing tl~is statement. I have reviewed the statement and to the pest of my knowledge the infor~lan~ontainej~erei~j~d i~e,~ched schedules is true and complete. I certif~ under penalty of perjury under the laws of the State of Califorr~a that the foregoing is true and corr~'~ / f/ ~ ~ DATE CITY ANO STATE ~ SIGNATURE OF CANDIDATE/OFFICEHOLDER Executed on At By DATE CITY AND STATE SIGNATURE or CANDIDATEK)FFICEHOtDER Executed on At By DATE CITY AND STATE SIGNATURE OF CANDIDATE/OFFICEHOLDER FOR INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF lg77, SEE INFORMA11ON MAN~JAL ~N CAMPAIGN DISCLOSURE PROVISIONS OF THE POLITICAL REFORM ACT.