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<br />Officeholder, Candidate, <br />and Controlled Committee <br />Campaign Statement - Long Form <br />(Governmenl Code Sections 84200-84216.5) <br />SEE INSTRUCTIONS ON REVERSE <br />Check one 01 Ihe lollowing boxes to indicate the type 01 statement being filed: <br />0 Pre-election Slalemeni <br />0 Supplemenlal Pre-eleclion Statemenl (Attach a completed Form 49510 this slalement.) <br />0 Special Odd-Year Campaign Report <br />!XI Semi-annual Slatemenl <br />t:J Termination Slalement (Attach a cOmpleled Form 415 10 this stalement.) <br />Officeholder, Candidate, and Controlled Committee <br />Included in this Statement <br />NAME OF OFFICEHOLDER OR CANDIDATE <br /> <br />Type or print in Ink. <br /> <br />1)w.¡c; , ~ <br /> <br /> <br />(NO. AND STREET) <br /> ¡;; <br />CITY STATE ZIP CODE AREACODEIDAVTIMEPHONE <br /> <br />~'~ ..~m~ :ï~'~~ <br />COMMITTEENAM: ' 1iëìo L '94~::;9 <br />COMMITTEE ADDRESS(NO. AND STREET) <br />; , ~ <br />CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE <br />~ (DJ1Y {ð~ q4{;h2 ¡;" <br />NAME OF TREASURER <br />M<,1,I~ S. ß.AI~ <br />PERMANENT ADDRESS OF TREASURER (NO. AND <br /> g <¡;),,~ <br />CITY STATE ZIP CODE AREA CODEIDAYTIME PHONE <br />'=R~ ~ ~ "7<1t: s <br /> <br />COVER PAGE - t.QNG FORM <br /> <br />Irom <br /> <br /> <br />Dale Siamp <br /> <br />CALIFORNIA 490 <br />994 FORM <br /> <br />age~OI~ <br />For Official Use Only <br /> <br />through' <br /> <br /> <br />~ ("' ~ ~ n~ ~ <br />I ,i); f' . \/,.' Þ . <br />- '"'" , ~ II <br /> <br />Date 01 election if apPlicabl1=i' ¡ JUl 3 0 1999 I : <br />(Month, Day, Year) U cJ <br /> <br /> <br /> <br />CITY <br /> <br />II Other Committees Not Included in this Statement: Listanyolher <br />committees nol included in Ihis consolidated slalemenl Ihal are controlled by you and <br />any committees of which you have knowledge thai are primarily formed to receIve <br />contributions or to make expenditures on behalf of your candidacy. <br />COMMITTEE NAME 1,.0. NUMBER <br /> <br /> <br />NAME OF TREASURER CONTROLLED COMMITTEE? <br />DYES DNO <br /> <br />COMMITTEE ADDRESS <br /> <br />(NO. AND STREET) <br /> <br />CITY <br /> <br />STATE <br /> <br />AREA CODE/DAYTIME PHONE <br /> <br />ZIP COOE <br /> <br />COMMITTEE NAME 1,.0. NUMBER <br /> <br />NAME OF TREASURER CONTROLLED COMMITTEE? <br />DYES D NO <br /> <br />COMMITTEE ADDRESS <br /> <br />(NO. AND STREET) <br /> <br />CITY <br /> <br />STATE <br /> <br />ZIP CODE <br /> <br />AREA CODE/DAYTIME PHONE <br /> <br />Anach addilional infom>a#on on appropriately labeled con#nua#on sheets. <br /> <br />III Verification <br />I have used all reasonable diligence in preparing this stalement. I have reviewed the slalemenl and 10 the best of my know! <br />complele. I certify uþ;~'ty 01 pe~ury under the laws 01 lhe Slale of Califomia lhallhe foregoing is true and c, <br />Execuledon ~ At ~~:r.t (f/Jl- By _Hr~~~E. ~ ~ <br />C AND STATE SIGNATURE OF TREASURER <br />An officeholder or candidate who controls a committee must also verify the campaign statemenU have used all reasonable diligence and to the best 01 my knowledge the treasurer has used all <br />reasonable diligence in preparing this slalement. I have reYiewed Ihe statement and to Ihe best of my knowledge the informationcontained herein and in the attached schedules is true and complete. I certify <br />under penally of 7.:.~Ury ¡nder the laws 01 (h tale of Califomia lhalthe foregoing is true and correct. ~ . ~ .J <br />Execuledon ~:.:;30 q<f' At By '.L'Af--'~ Y"./.Að <br />DATE CITY AND AT SIGNATURE OF CANDIDATEIOFFlC£HOlDER --- <br /> <br />Executed on <br /> <br />At <br /> <br />DATE <br /> <br />CITY AND STATE <br /> <br /> <br />'rein and in the attached schedules is Ime and <br /> <br />By <br /> <br />SIGNATURE OF CANOIDATEIOFFICEHoLDER <br /> <br />Execuled on DATE AI CITY AND STATE By SIGNATURE OF CANDIDATEIOFFICEHOLDER <br />FOR INFORMATION REOUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 19TT. SEE !!!EQBMAWN MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLITICAL t!E£Q!!M..AOI. <br />State of California Fair POlitical Practices Commission <br />