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, officeholder, Candidate, typ.or print inink. COVER PAGE- LONG FORM <br /> <br /> and Controlled Committee Statement covers pariod DateStamp <br /> Campaign Statement -- Long Form <br /> (Government Code Sections 84200-84216.5) <br /> SEE INSTRUCTIONS ON REVERSE '~:~. ' =i~ i .' .L: i-'=~ Page <br /> Check one of the following boxes to indkata the type of statement being filed: Date of election ff a __ <br /> B Pre-election Statement (Month. Da I For Official Use Only <br /> Supplemental PrHlection Statement (Attach I completed Form 495 tothis statement.) J U L 3 1 t995 ! <br /> Special Odd-Year Campaign Report <br /> Semi-annual Statement <br /> Termination Statement (Attach a completed Form 41S to this statement.) 0 F R E D W 0 0 D <br /> :nt: <br /> lis Statement <br /> coma/flees of which you have knowledge that are primarily formed to receive contr/but/orts <br /> *' ' I ~ " or to .ke e,pendi~ures on behaff of rour candtd~cT/. <br /> COIdMitTlI NAME LO. NUMIEA <br /> OFFICE SOUGh. QR ML~ ~ LOCATION AND DfiSTRICl' NUMMA iFIM'PUCa~.E) <br /> <br /> / '~ NAM! 04~ TI~.ASUIIER COflTIK)LLED COMMITTEE? <br /> <br /> CITY ' , ~ STATE ' ~ C AREA COMMITTll aSS Od). AND STREET) <br /> <br /> COMMITTEE NAME ~ -- ' J LO. NUMMR CITY STATE ZIP COiX AI~.A COOF. JOAYTIME PHONE <br /> <br /> I~IMANINT AOOMSS Ot TMASI~I[R (NO, ANO STIISET) OTY STATE ZIP COOE AREA COOFJI~YTIME PflO~ <br /> <br /> crr~ STATE Z~ COM AMA C00e~YTmE <br /> AIIKh add~ional informatk~ on appropriately labeled ¢ondnuadon sheets. <br /> <br /> true and complete. I ~erti~ Lu_nderj)enelty of pa~juryAu.nde~r t_heJ~ws)ef tile state of,~fornJa that the toregoingjls l~ue ano/ccjp~q,~--7 ~ <br /> <br /> An officeholder or ~ndldate whe ¢ontroll I committee mu~t Ilso lerif~ie campalln ~tltament. I have u~d all re~on~blt diligence ~H~d t~ the best of my knowledge the treasurer his used all <br /> ~easonable diligence in preparinj this statement. I have reviewed the statement and to the best of my knowledge t/~e intormati~n..~.~n~.~i~d herein and in the attached schedules is true <br /> complete. ~ert~fy~nd~rpan¥~ty~f~f~e~uryund~R~h~ws~th~tat~eef.~a~i~rniat~&~th~reg~ingis~rUe~nd~r~ect~ .~ /[ ~1 _ <br /> <br /> Executed on, At k,~ By <br /> v <br /> <br /> DATE CITY AND STATE SIGNATURE OF CANDIDATE/OFFICEHOLDER <br /> Executed on At By <br /> DATE CITY AND STATE SIGNATURE OF CANDIDATE/OFFICEHOlDER <br /> <br /> FOR INFORMATION REQUI~D TO SE PROVIDED TO YOU PUIL~UAN1 TO rile INFORMATION PRACTICES ACI OF lg77, SEE INFORMATION MAH~JA~. d~)N CAMPAIGN DISCLOSURE pROViSIONS OF THE POLIIICAL REFORM ACT. <br /> <br /> <br />