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<br />Type or print in ink. <br /> <br />Officeholder, Candidate, <br />and Controlled Committee <br />Campaign Statement - Long Form <br />(Government Code Sections 84200-84216.5) <br />SEE INSTRUCTIONS ON REVERSE <br />Check one of the following boxes to Indicate the type of statement being filed: <br />B Pre-election Statement <br />Supplemental Pre-election Statement (Attach a completed Form 495 to this statement.) <br />Special Odd-Year Campaign Report <br />Semi-annual Statement <br />Termination Statement (Attach' completed Form 415 to this statement.) <br />d Controßëa Commit'iië <br /> <br /> <br />94 \4 9~ <br /> <br />,'-.)fë <br />I COMMmu ADDIIISS (ND. AND STIIIET) <br />~ A~ <br /> STATE ZIP CODE AIIIA COOfIDA YT"E PHONE <br /> <br />~ Urj. & ~Lf1f~)~ <br /> - <br />~,.~ <br /> <br />PERMANENT ADOIIESS Of TREASUREII (NO. AND STREET) <br />~ <br /> <br />OTY <br /> <br />STAn <br /> <br />lIP CODE <br /> <br />AIIEA COOEJDA YTIME PHONE <br /> <br />It <br /> <br />COVER PAGE - LONG FORM <br /> <br />Statement covers period <br /> <br /> <br />Date Stamp <br /> <br />from <br /> <br /> <br />ofL <br /> <br />For Official Use Only <br /> <br />through <br /> <br />Date of election If applicalfle: <br />(Month. Day. Year) <br /> <br />JAN3'S9l <br /> <br /> <br />ther Committees Not InCluded in this Statement: Ustlnyother <br />committees not Included in this consolidated statement tINt Ire controlled by you and any <br />committees of which you INlle knowledge that are primarily formed to receille contributions <br />or to make expenditures on beIN" of your (lndlclaC'l. <br />cOMMmEE NAME <br /> <br />1.0. NUMIER <br /> <br />NAME Of TIIIASURER <br /> <br />CONTROlLED COMMmEE? <br />OmONO <br /> <br />COMumu ADORESS <br /> <br />(NO. AND STREET) <br /> <br />crrv . <br /> <br />STATE <br /> <br />UlCDOE <br /> <br />AREA CODEIDA YTIME PHONE <br /> <br />COMMmEE NAME 11.0. NUMIER <br /> <br /> <br />NAME Of TREASUREII CONTROllED COMMmEE? <br />Om p~ <br /> <br />COMMITTEE ADOIIESS <br /> <br />(NO. AND STIIIET) <br /> <br />., ! <br /> <br />OTY <br /> <br />STATE <br /> <br />lIPCDOE <br /> <br />AIIIA CDOEIDAYTIME PHONE <br /> <br />Attach addItJona/lnformatJon on appropriately labeled continuation sheets. <br /> <br />tained herein and in the attached schedules is <br /> <br />m Vermëãiion ---- <br /> <br />I have used a/l reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my k <br />true and complete. I certify under penalty of ~y under the laws of the State of California that the foregoing is tt <br /> <br />Executed on .... 1- ~ -tl At ~ ðrý By <br />DATE CRY.(NDSTATE <br /> <br />An officeholder or candidate who controls a committee must also verify the campaign statement. I have used all reasonable diligence and to the best of my knowledge the treasurer has used all <br />reasonable diligence in prep.ring this statement. I have reviewed the statement and to the best of my knowledge the information contained herein and in the attached schedules is true and <br />complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true ~ ~ ~ <br /> <br />Executed on At 8Y+-:£ < -tIL.A <br />DATE CRY AND STATE SIGNA TUllE Of CANDIDATE flEfII8lBEII--.. <br /> <br />Executed on At By <br /> <br />DAn <br /> <br />OTY AND STATE <br /> <br />Executed on <br /> <br />At <br /> <br />CRY AND STATE <br /> <br />fOR INfORMATION REQUIIIED TO IE PROVIDED TO YOU PUIISUANT TO THE INfORMATION PRACTICES ACT Of 1'17. SEE INfORMAl ION MANUAL Of! CAMPAIGN DISClOSURE PROVISIONS Of THE POLITICAL RHORM "CT <br /> <br />DATE <br /> <br /> <br />SIGNATURE Of CANDIDAnlOfflCEHOlDER <br /> <br />By <br /> <br />SIGNATURE Of CANDIDATEIOfFICEHOlDER <br />