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' COVERH4GE <br /> � tecipient Committee 7ype or print in ink. oa�e Siamp <br /> :ampaign Statement � �; � ' � • 1 <br /> :over Page � � � � <br /> .iorernment Code Sedions 84200-84216.5) �{ � �1 <br /> Statement covers period Date of election If appllcabl p Page� of��a,� <br /> . from ��— �4 —�� (MonM, Day, Veer) NOV 4 Z�ou for Otlicial Use OnN <br /> g �/'—��d 0 -�✓ u i� � D� a�v aciTV cLER°c°�irr <br /> EE INSTRUC710NS ON REVERSE throu h <br /> . Type of Recipient Committee: nn commi�ceea-compiece raro+,x,a,a�a+. 2. Type of SWtement: <br /> ❑ Officeholder,Candidate Controlled Committee � P�imarily Formed Ballot Measure [�. Preelection Stetement � Quatlerly Statement <br /> (� State Candidate Election Committee Committee ❑ Semi-annual Starement � Special Odd-Year Report <br /> (�j Recall Q Controlled ❑ TerminationStatement [] SupplementalPreelection <br /> rasocompie«Partsl Q Sponsored (Also file a Form 41 Termination) Statement-Atlach Form 495 <br /> (Nso Gomrybfe Part 6) <br /> � General Purpose Commiitee ❑ Amendment(Ezplain bBlow) <br /> Q Sponsored � PrimadyFOrtnedCandidate! <br /> CSmaIIConlributorCommittee OffceholderCommittee <br /> QPoliticalParty/CentralCommittee �aroco�.m�erovart�l <br /> .. Committee Information I.D. NUMBER Treasurer(s� <br /> /3 � �� 6 3 /l.4�� .����2 rF iVSv�J <br /> COMMITTEE NAME (OR CANOIDATE'S NAME IF NO COMMITiE/E)� NAME OF TREASURE <br /> C�.i?i L��US To ?�!L�"E:[7 �i�'Ou.'ov0 Lrrr �oc.r�ua� /�ciiU,(/ <br /> COMh1/T/EE MAILING ADDRESS /� <br /> �Epwo 00 �.`��1/ �A- �7Yo�'Z <br /> STREET ADORE55 (NO/P.O`. BO%) CITY STATE ZIP CODE . AREA CODEIPHONE <br /> �£-OC�oci � C.� TV Gr 9voc, 'L <br /> CITV STATE ZIP CODE AREA COOE/PHONE NAME OF ASSISTANT TREASURER, IF ANY <br /> �i o 3pX a i � <br /> N-A-IL-�ING AODRESS (�F DIFFERENT) NO.AND STREET OR P.O. BO% MAILING ADDRE55 <br /> i� ,ovc� C'� T✓ C�A- �l�/db '`7� - 2.iG�.� <br /> CITV S ATE ZIP CODE AREA CODE/PHONE Cliy STATE ZIP CODE AREA COOEIPHONE <br /> OPTIONAL: FAX!E-MAIL A�DRE55 OPTIONAL FA% I E�MAIL AODRESS <br /> . Verification <br /> !have used all reasonabte dilgence in preparing and reviewing this statement antl to the best ot my koowledge the intortnation contained herein and in the attached schetlules is true and complete. I certify <br /> under penalry of perjury under the laws of the State of Califomia that the foregoing is tme and �Red. y - <br /> + _.�'�-`._ <br /> //� y- U 8 �� <br /> Execu�etl on BY <br /> Da:e Sg lureaiTreasurera ss¢;aMTieawe� <br /> B <br /> Execut2tlon �Q Y SgretuealCmrtoArgOt�ceMitla.CerMa�x.StasMeaweP:ooareMwResparo�DkOnwrdSpansor <br /> ExecNedon BY SinptweoiCmtml OlficeholdetCeMAate,StateMeaz�rePraponern <br /> Date 9 M'B <br /> Exetu�etl On �e By <br /> SipwureofCarnmm+pOlfRa'metCaMmte.SieteMeaauePrcpa+eN FPPCFortn060(January/05) <br /> FPPC Toll-Frce Helpllne:B66/ASK-FPPC(866�275-]772) <br /> Sfate ot CaliPornla <br />