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� RecipientCommittee ��=^ �-��a� COVERPAGE <br /> Campaign Statement Type or print in ink. f 1�.,0� _a �� � � � � , <br /> g ,' � � • 1 <br /> (CG�oernemenPt�cod sections sazoo-8az�s.$) � ( OCT 2 3 2003 ;�� �•- � <br /> Statement covers period Date of election if applicab : �T•Y���. ��,�4`JUOJ CITY' � 9 <br /> (Month, Day,Year) Page of <br /> from 9/21/03 C�Ty ;�:LE�2i�. <br /> V ��.�.s.--_,.-.-- For Official Use Only <br /> SEE INSTRUCTIONS ON REVERSE through 10/18/03 11/4/03 <br /> 1. Type of Recipient Committee: ai comm�nees-comPiece aartg�,z,a,a�a a. 2. Type of Statement: <br /> m Officeholder,Candidate Controlled Committee � Ballot Measure Committee � Preelection Statement � Quarterly Statement <br /> Q State Candidate Election Committee 0 Primarily Fortned ❑ Semi-annual Statement <br /> Q Recall Q Controlled ❑ Special Odd-Year Report <br /> (AlsoComp/etePartSJ ❑ TerminationStatement ❑ SupplemenlalPreelection <br /> Q Sponsored � Amendment(Explain below) Statement-Attach Form 495 <br /> (Also Canplefe Part 6J <br /> ❑ General Purpose Committee <br /> Q Sponsored � Primarily Formed Candidate! <br /> Q Small Contributor Committee Officeholder Committee <br /> QPoliticalParty/CentralCommittee (A�soCa^Ple�ePart7) <br /> 3. Committee Information I.D. NUMBER Treasurer(s) <br /> 1255762 <br /> COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> Committee to Elect lan Bain Nancy Bain <br /> MAILING ADDRESS <br /> <br /> STREET ADDRESS (NO P.O.BOX) CITY STA7E ZIP CODE AREA CODE/PHONE <br /> Redwood City CA 94063 <br /> CITY S7ATE 21P CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY <br /> Redwood City CA 94063 <br /> MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O. BOX MAILING ADORESS <br /> CITY STATE ZIP CODE AREA CODE/PHONE CITY STA7E ZIP CODE AREA CODE/PHONE <br /> OPTIONAL: FAX/E-MAIL ADORESS OPTIONAL: FAX!E-MAIL ADDRESS <br /> ian C�3ianbain.com <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. 1 <br /> certify under penalty of perjury under the laws of the State of California that the foregoing is true and co ect. <br /> Executed on 10/23/03 BY i ' <br /> Date SignatureofTreas orASSisFantTreasurer <br /> Executed on 10/23/03 BY i ^ <br /> Date SignaWreofControllirg0(ficelpl er, rMidate,SWteM ureProponei#orResponsibleOficerofSporsor <br /> Executed on By <br /> Dafe SignaWre of Cantrdlirg 0lficehdder,Candidate.State Measure Pmpa�rt <br /> Executed on By <br /> Date SignaWreotControllirgOlfimholOer,Carbitlate,StateMeasureProponent FPPC Form 460(JUne/07) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC <br /> State of California <br />