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Recipient Committee T COVER PAGE <br /> ype or print in ink. Date Stamp � �. � <br /> Campaign Statement �. � • 1 <br /> CoverPage R CElVL� <br /> (Govemment Code Sections 84200-84216.5) � � <br /> Statement covers period Date of electio if appiicable: Page °f <br /> 7/1/15 (Month, D y, Year) � � �O�C For Official Use Only <br /> trom ,J N u <br /> SEE INSTRUCTIONS ON REVERSE th�ough 12/31/15 'ty af Redwood Ciry <br /> 1. Type of Recipient Committee: All Committees—Complete Parts 1,z,a,a�a a. 2. Type of t ' e <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 Termination Statement <br /> (AlsoCompieteParfSJ S onsored � ❑ SupplementalPreelection <br /> � P (Also file a Form 410 Termination) Statement-Attach Form 495 <br /> (A/so Complete Part 6) <br /> ❑ General Purpose Committee ❑ Amendment(Explain below) <br /> � Sponsored � Primarily Formed Candidate/ <br /> �Small Contributor Committee Officeholder Committee <br /> � Political PartylCentral Committee (AlsoCompletePart7) <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 /> STREETADDRESS (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. Verifcation <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best of my�wledge the information contained 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 corrsct. � <br /> Exec�tedon 1/22/16 BY ��/�� ,1�'�/��� ���L�� <br /> Date Signature of Treasurer or Assistant Tr�surer <br /> Executed on By <br /> Dale Signature of Contrdling Ofliceholder,Candidate,State Measure Pmponent or Responsible Officer of Sponsor <br /> Executed on By <br /> Date Signature of Contmlling Officeholder,Candidate,State Measure Proponeni <br /> Executed on By <br /> Date SignatureofControlNngOfficeholder,Candidate,StateMeasurePmponent FPPC Form4B0(January105) <br /> FPPC Toll-Free Helpline:8661ASK-FPPC(8661275-3772) <br /> State ot Calitomia <br />