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J <br /> COVER PAGE <br /> Recipient Committee <br /> ink. Stamp CALIFORNIA 460 <br /> Campaign Statement Type or print in Ink. Date s <br /> Cover Page ;,=y FORM <br /> � ,� is ,J p 1 i i <br /> (Government Code Sections 84200-84216.5) i i! 11 ' ' 1 17 of Statement covers period Date of election if ap rfrie:IUL 3 0 2009 Page Use <br /> from <br /> 1/1/09 (Month, Day,Yea i a For Official Use Only <br /> , n �1Tf i <br /> J1T) ��i •- : 1.: <br /> 6/30/09 11/3/09 ` `tw--.-°— <br /> SEE INSTRUCTIONS ON REVERSE through --°--" <br /> 1. Type of Recipient Committee: All Committees—Complete Parts 1,2,3,and 4. 2. Type of Statement: <br /> ® Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ® Preelection Statement ❑ Quarterly Statement <br /> Q State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report <br /> Q Recall Q Controlled <br /> El Termination Statement ❑ Supplemental Preelection <br /> (Also Complete Part 5) <br /> 0 Sponsored (Also file a Form 410 Termination) Statement-Attach Form 495 <br /> (Also Complete Part 6) <br /> ❑ General Purpose Committee ❑ Amendment(Explain below) <br /> Q Sponsored ❑ Primarily Formed Candidate/ <br /> Q Small Contributor Committee Officeholder Committee <br /> Q Political Party/Central Committee (Also Complete Pan 7) <br /> 3. Committee Information I.D. NUMBER Treasurer(s) <br /> 1313963 <br /> COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> JOHN SEYBERT FOR CITY COUNCIL Z 0'4%A RICHARD S. CLAIRE <br /> MAILING ADDRESS <br /> SAME <br /> STREET ADDRESS(NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE <br /> <br /> CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY <br /> REDWOOD CITY CA 94062 <br /> MAILING ADDRESS (IF DIFFERENT) NO.AND STREET OR P.O. BOX MAILING ADDRESS <br /> SAME <br /> CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE <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 knowledge the i rm. 'on contained herein and in the attached schedules is true and complete. I certify <br /> under penalty of perjury under he laws of the State of California that the foregoing is true and corre <br /> Executed A7 /If al - r�>L.r:.L <br /> d on By <br /> Da Signature of - , <br /> Executed on B y 1/L ArAff <br /> Date .a ure of Controllin.Officeholder,Candi•-"Tr,S■to Me-s e Pro,onent or Responsible Officer of Sponsor <br /> Executed on By <br /> Date Signature of Controlling Officeholder,Candidate,State Measure Proponent <br /> Executed on By <br /> Date Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 460(January/05) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) <br /> State of California <br />