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COVER PAGE <br />RecipientCommittee Type or print in ink. ~ Date Stamp <br />Campaign Statement <br />(Government Code Sections 84200-84216.5) <br /> IStatement covers p~i~d Date of election if applicablej ! J'/~ ~-/'J / of? <br /> from O/~ ~)/~ (Month, Day, Year) JlJ' OCT 2 ~ ]999 .. I For Official Ose Only <br /> <br />SEE INSTRUCTIONS ON REVERSE through /0--/~ <br /> <br />1. Type of Recipient Committee: A, Committees- Complete Parts 1,2, 3, and 7. 2. Type of Statement: <br /> <br /> ~,,~Officeholder, Candidate [] Primarily Formed Candidate/ .,~'Pre-election Statement [] Quarterly <br /> Statement <br /> · ' 'Controlled Committee Officeholder Committee [] Semi-annual Statement [] Special Odd-Year Report <br /> (Also Complete Par/4.) (Also Complete Par/6.) [] Termination Statement [] Supplemental Pre-election <br /> [] Ballot Measure Committee [] General Purpose Committee [] Amendment (Explain below) Statement - Attach Form 495 <br /> © Primarily Formed © Sponsored <br /> © Controlled © Broad Based <br /> © Sponsored <br /> (Also Complete Par/5.) <br /> <br /> J I.D. NUMBER <br />3. Committee Information q'~ / ~7~, Treasurer(s) <br /> COMMITTEE NAME NAME OF TREASURER <br /> <br /> STREET 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 A~Y <br /> <br /> MAILING ADDRESS (IF DIFFERENT) NO. AND ,~TREET OR P.O. BOX MAIL ADDRESS <br /> <br /> CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE <br /> <br /> OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS <br /> <br /> FPPC Form 460 (8~99) <br /> For Technical Assistance: 916/322-5660 <br /> State of California <br /> <br /> <br />