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Recipient Committee • COVER PAGE <br /> Campaign Statement Type or print in ink. Y' CALIFORNIA 460 <br /> Cover Page a FORM <br /> (Government Code Sections 84200-84216.5) JAN 24 Z012 Page 1 of 5 <br /> Statement covers period Date of election if appl :able: <br /> from <br /> 7/1/11 (Month, Day, Year) CITY OF REDWOOD CITY For Official Use Only <br /> CITY CLERK <br /> I <br /> SEE INSTRUCTIONS ON REVERSE through 12/31/11 <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 12I Semi-annual Statement ❑ Special Odd-Year Report <br /> Q 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 /> Q Sponsored ❑ Primarily Formed Candidate/ <br /> 0 Small Contributor Committee Officeholder Committee <br /> Q Political Party/Central Committee (Also Complete Part 7) <br /> 3. Committee Information I.D. NUMBER Treasurer(s) <br /> 1313693 <br /> COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> JOHN SEBERT FOR CITY COUNCIL 2009 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 /> 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 ggg i I have r penalty all of perjury under diligence e in preparing and reviewing this statement i and is the best Orr d e formation fined herein and in the attached schedules is true and complete. I certify <br /> under penalty of perjury u/nder the laws of the State of Califomia that the foregoing is true and corr f/ <br /> Executed on 7/23 /Z <br /> are By Si, =turaof,1/sur=y Assistant Treasurer <br /> Executed on I Dal at e t— By <br /> Si - .W mge Side Ca •-Vtat: easure Proponent or Responsible Officer of Sponsor <br /> Executed on <br /> By <br /> Date Signature of Controlling Officeholder,Candidate,State Measure Piyunent <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 Califomia <br />