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Officeholder,Can didate, Tv.o, print In Ink. COVER PAGE- LONG FORM <br />and Controlled Committee Statemen~¢o~arsperlod I DeteStamp <br />Campaign Statement --Long Form ~rom~ ~ ~ aa · . <br />(Governmant Code Sections 84200-84216.5) ,,k/'/~$I/q7 Il/! TS ~ L,; . w ~ In]l <br />Check one of the followlng boxeltolndl¢ltl the type of stltlment belng flled: Dateofelatlionff'appllclble: IIIII ccn am7 I -~,Z~.,-:;:'-- <br /> [-1 Pre-electionStatement (Month. Day, Ye,r}I~! '~ "'~' I!-'/I ...............' <br /> I-I Supplemental Pre-election Statement (Attach a completed Form 495 to this statement.) . I I i I I I <br /> <br /> : II~ any other <br /> Inclu tatement committees not Induded ln this ¢onzolldated ~etement that are controlled by you and any <br /> NAME OF.OFFICEHOLDER OR CANDIQATE ~ /~ / come/trees of which you have knowledge that ere primarily fo~med fo rerelve ¢ontrlbutlom <br /> <br /> - COMMITr ES NAME <br /> O~fKE rOUGe.OR EtO( NCtUDE U~,~ ~6N D RIST ' ItEL rD. NUMIER <br /> <br /> RESIDENTIAL NAME Of TREASURER CONTROtLEO COMMI'FIEET <br /> <br /> COMMITTEE N~ME __ cnY <br /> <br /> C~M~E! ADDRESS / (NO. AND STMET) I <br /> I <br /> <br /> NAME OF ~E~URER C~M~! ADD~t~ (NO. AND <br /> PE~ANE~ ADD~ESS ~ ~A~URER (NO. AN~REET) C~Y STATE <br /> <br /> C~Y ~ / $TATE ZiP COD[ l~l CODE~AYTIM[ ~[ <br /> <br />III V~rifi~atio. ~ ' .' <br /> I h~v~ u~d all rla~nlbl~ dllig~Kt I~ preparing this statement. I have reviewed the statement and to the ~. of my tgowl~dge the Informatlo~aln~ <br /> true and ~ompltte. ,I [l~fy under ~nal~ of ~rj~y upd~r th~ I~wt o~tht Stall of {alilomia that the forgoing h tru~and ~orre~. ~ ~ <br /> <br /> An offlclhoMtr ~ ~lditl who controls I ~omml.ll must lho verify thl campaign stattm~nt. I have used all reason~blt dili~ce ~.d to the hat of my tn~lldge the treasurer has used ~11 <br /> ~ilsonibli dlligtncl In preparing this statement. I have reviewed the stittmlnt and to the hat of m~ knowledg~ the inlo~mitio~contat.ld herein and in the i~ached schldulls il true and <br /> c°mp"'" .c.~fy~nd.r~n..~y~'"rjuryundeA~h.`..w~'the~.~.pfC...f~rn..th.~he'~eg~.ng.s~ru..ndc~~Ex~cu~d~n//~//~ ~ At ~('~ ~'~ ~/¢ C* By ~/~ /~4 <br /> Executed on , At By <br /> DAlE CnY AND STALE ( SIGNATURE Oe ~NDIDAIE~FIIC[~D[~ <br /> <br /> Executed on At By <br /> DATE CI~Y AND STA~[ ~IGNAIUA[ Of ~NDIDA?E~F~IC[HOLDER <br /> <br /> FDA INF~M&TION ~E~IA~O TO BE PAOV~DED TO YOU PURSUANT TO THE INFOAM&TION P~IC[~ A~ OF ~77, SEE INFORMATION MANUA[ ON ~M~AIqN DISCt~$~A[ FA0VlII~N~ OF ?HE P~m~[ <br /> <br /> State otCalifmnle Fair Political P~ectlces Commission <br /> <br /> <br />