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COVER PAGE <br /> Recipient Committee Type or print in ink. Date Stamp <br /> Campaign Statement CALIFORNIA 460 <br /> Cover Page FORM <br /> (Government Code Sections 84200-84216.5) 1 16 <br /> Statement covers period Date of election if applicable: ` ...3 0; c� Page of <br /> 7/1/09 (Month, Day,Year) For Official Use Only <br /> from <br /> 11/3/09 _. <br /> SEE INSTRUCTIONS ON REVERSE through <br /> 9/19/09 <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 2 Preelection Statement ❑ Quarterly Statement <br /> 0 State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report <br /> O Recall 0 Controlled ❑ Termination Statement ❑ Supplemental Preelection <br /> (Also Complete Part 5) 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 /> O Sponsored ❑ Primarily Formed Candidate/ <br /> 0 Small Contributor Committee Officeholder Committee <br /> 0 Political Party/Central Committee (Also Complete Part 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-2009 1��— 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 k••wledge the • e,rmati..' contai ed herein and in the attached schedules is true and complete. I certify <br /> under penalty of perjury under the laws of the State of California that the foregoing is true and c• .. <br /> Executed on 9/�24�/09 By / i. Ad ta„�,� <br /> .i•'ature of Tre ss <br /> l ista• Airg <br /> 9/24/09 ' ALA „waif <br /> Executed on By <br /> Date '••••msr"!-- on ro ing 0 ho•er,Candidate,S-; l•'u-- •• • Responsible Officer of Sponsor <br /> Executed on By <br /> Date Signature of Controlling Officeholder,Candidate,Sta a easure 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 />