Laserfiche WebLink
Recipient Committee COVER PAGE <br /> Campaign Statement Type or print in ink. Date Stamp <br /> CALIFORNIA 460 <br /> Cover Page 1 FORM <br /> (Government Code Sections 84200-84216.5) s 1 6 <br /> Statement covers period Date of election if applicable: ., Pag-.of <br /> 1/1/12 (Month, Day,Year);' 11 J for Official Use Only <br /> from JUL i 212 <br /> SEE INSTRUCTIONS ON REVERSE through 6/30/12 <br /> a ' <br /> 1. Type of Recipient Committee: All Committees—Complete Parts 1,2,3,and 4. 2. Type of Statem nt: <br /> ® Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Stat2 ❑ Quarterly Statement <br /> Q State Candidate Election Committee Committee V Semi-annual Statement ❑ Special Odd-Year Report <br /> Q Recall 0 Controlled <br /> El Termination Statement [7] 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 I1 'Amendment(Explain below) J' <br /> Q Sponsored ❑ Primarily Formed Candidate/ T/2db16 x� TO - /6's/ ��C/ l.' <br /> O Small Contributor Committee Officeholder Committee J� .�7 <br /> O Political Party/Central Committee (Also Complete Part 7) <br /> 3. Committee Information l'D�l;NUMBER Treasurer(s) <br /> COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) - NAME OF TREASURER <br /> JOHN SEYBERT 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 <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify <br /> under penalty of perju^ryy under the laws of the State of California that the foregoing is true and core- t. <br /> •Executed on f/3i/'. Oa- By / /4/ A �,: <br /> /2ate 0 ssistant Treasurer <br /> Executed on �/ ! 2 M ��Ai <br /> ate 4nat'Controlling Officeh:der, - didate,State M•asure Proponent 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 />