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COVER PAGE <br />Recipient Committee Type or print in ink. Da~e Stamp <br />Campaign Statement <br />Cover Page ~ ~ ~i,! <br />(Government Code Sections 84200-84216.5) <br /> Statement covers period Date of election it applicable: Page_ / oi ~ __ <br /> =rom /~--~'~' (Monlh, Day, Year) ~ JAN 3 <br /> ~ Fo~ Olliclal Use Only <br /> <br />1. Type of Recipient Committee: All C~mmitlees - Complete Pa~s 1, 2, 3, and 4. 2. Type of Statement: <br /> <br /> ~ Officeholder, Candidate Controlled Commi~ee ~ BallolMeasareCommiltee' ~ PreelecflonStalement ~ Qua~erlySlalemenl <br /> O State Candidate Election Commgtee O Primarily Formed ~ Semi-annual Statement ~ Special Odd-Year Repo~ <br /> 0 Recall 0 Controlled ~ Termination Sl~temenl ~ Supplemental Preeleclion <br /> (~oC~p~ePa~5~ O Sponsored ~ Amendment (Explain below). Statement - Attach Form 495 <br /> <br /> General Purpose Commigee <br /> Primarily Formed Candidate/ <br /> ~ Sponsored ~ Ogiceholder C~mi~ee <br /> ~ Small Conlributor Commiaee <br /> 0 Polilical Pa~y/Central Commgtee (A~ C~t~ Pa~ 7) <br /> <br /> Committee Information ] I.D. NUMBER ~ ~--/ Treasurer(s) <br />3. <br /> <br /> COMMITTE~ NAME (OR CANOIDATE*S NAME IF NO COMMITTEE) NAM~TREASUR R~R R <br /> <br />4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the besl of my knowledge the intormalion conlained herein and in lhe attached schedules is true and complete. I <br /> cedgy under penatty of ,perjury under the laws of the State o! California that the foregoing is flue and cq~. , ~ <br /> <br /> / <br /> <br /> By FPPC Form 460 (Jun~01) <br /> <br /> <br />