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PAGE <br /> Recipient Committee Type or print in ink. Date btam• CAL FORMA /�460 <br /> Campaign Statement IRECEVEP T <br /> Cover Page FORM <br /> (Government Code Sections 84200-84216.5) 1 7 <br /> Statement covers period Date of election if appli ble: JAN 3 1 2014 Page of <br /> 10/20/13 (Month, Day, Year) `t -or Official Use Only <br /> from <br /> CITY OF REDWOOD CITY <br /> BEE INSTRUCTIONS ON REVERSE through 12/31/13 <br /> CITY CLERK <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 21 Semi-annual Statement ❑ Special Odd-Year Report <br /> Q Recall 0 Controlled Termination Statement <br /> (Also Complete Part 5) 0 Sponsored ❑ Satement-AtachFormn <br /> (Also file a Form 410 Termination) Statement-Attach Form 495 <br /> (Also Complete Part6) 0 <br /> ❑ General Purpose Committee Amendment(Explain below) <br /> 0 Sponsored ❑ Primarily Formed Candidate/ <br /> Q Small Contributor Committee Officeholder Committee <br /> Q Political Party/Central Committee (Also Complete Port7) <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 2013 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 NA <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 1 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 fwledge th- formation contained herein and in the attached schedules is true and complete. 1 certify <br /> under penalty of perjury un•er the laws of the State of California that the foregoing is true and col,-.. <br /> ` r <br /> Executed on ! By AiG 7/e Al • r �!✓.� <br /> Date .: reds •• <br /> Executed on <br /> / 3f j :. 1111111 � �M■ <br /> pet_ reafCon.•. gOftceholder,Ca did: :,StateM:F ureP:••onentor Responsible Officer ofSponsor <br /> Executed on By <br /> Data Signature of Controlling Officohotder,C•■ te,Slate Measure Proponent <br /> Executed on By <br /> Date SignatuteofControlling Officeho lder,Candidata.State Measure Proponent FPPC Form 460(January/05) <br /> FPPC Toll-Free Helpline:8661ASK-FPPC(8661275-3772) <br /> State of California <br />