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. ` <br /> � COVER PAGE <br /> f�r�cipient Committee Type or print in ink. Date Stamp <br /> Campaign Statement � �� � ' • � <br /> Cover Page <br /> (Government Code Sections 84200-84216.5) page�— of <br /> Stateme t cov rs period Date of election if applicable: „ , <br /> 3 " (Month, Day,Year) �.. , �. E ;;;7 For Official Use Only <br /> from <br /> SEE INSTRUCTIONS ON REVERSE thl'OUgh �� <br /> � � � I � � � <br /> 1. Type of Recipient Committee: All Committees—Complete Parts 1,2,a,and 4. 2. Type of Statement: <br /> '`Sd�Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure �,�Preelection Statement � Quarteriy Statement <br /> ��`�State Candidate Election Committee Committee ❑ Semi-annuai Statement � Special Odd-Year Report <br /> Q Recall Q Controlled � Termination Statement � Supplementai Preelection <br /> (AlsoCompleteParfS) Q Sponsored (Also file a Form 410 Termination) Statement-Attach Form 495 <br /> (Also Complete PaR 6) <br /> ❑ General Purpose Committee ❑ Amendment(Explain be�ow) <br /> Q Sponsored � Primarily Formed Candidate/ <br /> Q Small Contributor Committee Officeholder Committee <br /> Q Political Party/Central Committee (��CompletePart7) <br /> 3. Committee Information �•D. NUMBER ��� Treasurer(s) <br /> COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TR SURE�2 <br /> ��1�,�r'1� �(•t�� ' (✓�.- �./i`� ��L��`� MAILING ADDRESS �� a <br /> y �� <br /> STREET ADDRESS(NO P.O. BOX) CITY � �\ ST_AT� �IP�ODE� ��C�E/�NE� <br /> <br /> �1l CitY ( <br /> CITY �h�,^�4 � r _�� STATE ZIP CODE��� A�A�OD�H�'���� NAME OF ASSISTANT TREASURER, IF NY <br /> � i r- n <br /> c., r r�,,�; �is �''1 �y � <br /> MAILING ADDRESS (IF DIFFERENT) NO.AND STREET OR P.O. BOX MAILING ADDRESS <br /> CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODElPHONE <br /> OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS <br /> 4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best of,my d he' rma' c tained herein and in the attached schedules is true and complete. I certify <br /> under penalty of perjury under the law of the State of California that the foregoing is true and ct <br /> � <br /> � <br /> Executed on °�� �� � BY � � � <br /> e �J SignatureofT easurerorAssistantTreasurer <br /> Executed on ��' � BY �� �• 7e1 V�� <br /> SignatureofControtli iceholder,Cand� ate,StateMeasureProponentorResponsibleOfficerofSponsor <br /> Executed on BY <br /> py� Signature of Controlling Officeholder,Candidate,State Measure Proponent <br /> Executed on BY <br /> p� SignatureofComrdlingOfficehdder,Candidate,StateMeasureProponer�t FPPC Form 460(January105) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) <br /> State of California <br />