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COVERPAGE <br /> Recipient Committee Type or print in ink. oate Stamp <br /> Campaign Statement •" � � � <br /> Cover Page 2 (I;,�, 2 �I� p1qp1 �[C " ' <br /> (Government Code Seclions 84200-84216.5) � '�+ � u u ° � <br /> Statement covers period Date of election if applicabl �_ � <br /> ,///0 3 (MOn�h, Day, Year) gEp 2,�'`g 2003 Page of <br /> from � <br /> For Official Use Only <br /> SEE WSTRUCTIONS ON REVERSE throu h D� I� � CITY OF FED':+OCO CRY <br /> 9 C�'l'CLoRK <br /> 1. Type of Recipient Committee: ai comm�nees-comP�ie rans i,�,a,a�d a. 2. Type of Statement: <br /> � Officeholder,Candidale Controlled Commitfee ❑ Ballot Measure Comminee ❑ Preelection Statement � puaderly Statement <br /> Q State Candidate Election Committee Q Primarity Formed ❑ Semi-annual Statement � Special Odd-Year Report <br /> � Re��� Q Controlled <br /> ❑ Tertninalion Slatement <br /> (AlmCompk�ePart5) Q Sponsored ❑ SupplementalPreelection <br /> (AlsroCOmpkfePetl6J ❑ Amendment (Explain below) Statement-Attach Form 495 <br /> ❑ General Purpose Committee <br /> Q Sponsored � Primarily Formed Candidale/ <br /> Q Small Contnbubr Commitlee OKceholder Committee <br /> �POliticalParty/CenlralCommiltee la.roComp�eieaart�) <br /> 3. Committee Information �D. NUMBER Treasurer(s) <br /> � 7 <br /> COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> R►eH��n 5. G.�a ia� <br /> MAILING ADORESS <br /> ROSAhM1E FpVST FGR GtTY Gx�JCtL �, <br /> STREET AOORESS (NO PO. BOX) CITY STATE ZIP CODE <br /> ,� <br /> CITV STATE ZIP CODE AREA COOE/PHONE NAME OF ASSISTANT TREASU R, If ANY <br /> RE�wmD Cir,I CA 9�2 <br /> MAILING AODRESS (IF DIFFERENT)NO.AND STREET OR PO. BOX MAILING ADORESS <br /> GTY STATE ZIP CODE AREA COOE/PHONE CITY STATE ZIP COOE AREA CODE/PHONE <br /> OPTIONAL FA%/EMAIL ADORESS OPTIONAL FA%/EMAIL ADDRESS <br /> 4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowled e the i rmation contained herein and in the attached schedules is true and complete. I <br /> certify under penally of perjury under the laws of the State of Califomia ihat thBYforego� �nd co��/� <br /> • <br /> Ezecu�ed on � • <br /> Dale ignaW Treawrera SsianlTreasurer <br /> Executed on � <br /> ey <br /> Sg eoiCm ing wahoper, Ie.51a �ureProponenlnResponvde�radSponsor <br /> Executed on gy <br /> � SiqneWre dCanVaNnp Otf�lwltler.CaMidale,Slale Measure Prtppienl <br /> Executed on gy <br /> �� SgnawreofCOnwpirgplkenqC¢r,Carqiaam,S�alel.teasvreP�oponem FPPCFOrm060(June/01) <br /> FPPC Tol�-Free Halpline:86WASK-FPPC <br /> - State o/Calibmia <br />