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COVER PAGE <br />'" ""~ *,.ec,~,,en, Committee Type or print in ink. Date Stamp <br />· Campaign Statement <br />Cover Page ~ ~ ~ <br />(Government Code Sections 84200-84216.5) ~ E C E ~ <br /> from ,~)'~'/~'--O~:) (Month, Day. Year) DEC 1 0 2003 I~ ,,,ge I e, ¢ <br /> · For Olliclal Use Only <br /> SEE,NSTRUCT,ONS ON REVERSE through /~-/''//''' ~ ~ ///''/';/- ~ -,% CiTY OF' REDWOOD CITN <br /> CITY CLERK <br /> 1. _~pe of Recipient Committee: A. Committees - Complete Paris 1, 2, 3. and 4. 2. Type of Statement: <br /> [] Officeholder, Candidate Conlrolled Committee [] Ballot Measure Committee [] PreeleclionStalemenl , [] QuaderlyStatement <br /> O State Candidate Election Committee O PrimadlyFormed [] Semi-annualStalement [] Special Odd-Year Repod <br /> O Recall O Controlled .,~Termination Statement [] Supplemental Preelection' <br /> (a~soCo,Ao~efePa,~s) O Sponsored <br /> (A~ocomp~etePa~6) [] Amendmenl (Explain below) Slalement - Attach Form 495 <br /> [] General Purpose Commiflee <br /> O Sponsored [] Primarily Formed Candidale/ <br /> O Small Contributor Committee Officeholder Committee <br /> O Political Party/Central Committee (,~o c~.~e Pa, ~) <br /> <br /> II.D. NUMBE.R~ -- ~-- <br /> 3. Committee Information /~)- ,_5 ~'/--'/~-~ / Treasurer(s) <br /> COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)_ __ NAME OF TREASURER <br /> <br /> MAILING ADDRESS <br /> ST~..EET 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 /> <br /> MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS <br /> <br /> CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE <br /> <br /> OPTIONAL: 'FAX I E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS <br /> Os-o- 0°0o2 - Og olo <br />4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and Io the best o! my knowledge the information contained herein and in the attached schedules is true and complete. I <br /> cedify under penalty of perjury under the laws of the State of California that the foregoing jJ'l'~an~correcL <br /> <br /> Executed on By ~ " · <br /> <br /> Executed on By <br /> Dale Signature d C*:~t, n3~g Oqlceholde~, Candidate, Stele Measure Profxx~nt <br /> <br /> Executed on By <br /> <br /> FPPC Toll-Free Helpllne: 866/ASK-FPPC <br /> Stale of Cellfornle <br /> <br /> <br />