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<br />m Verification . <br />I have uMd a/l reasonable diligence In prep.ring this atement. I have reviewed the statement and to the best of my k~p.thelPfor~iøJt:ltørtjiined herein and in the attached Khedules is <br />true and complete. I certify ~nder ~R81ty of PI. er thela of t e State alifornia that the foregoing is tr <br />Executed on 3-,(';1. ~ #- At By <br />DATE <br /> <br />An offkeholder or candidate who controls a committee must also verify the camp.lgn statement. I have used all reasonable diligence and to the best of my knowledge the treasurer has used a/l <br />reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained herein and in the attached Khedules is true and <br />complete. I certify under penalty of perjury un er the laws of the s~ate of California that the foregoing is tru~orrect. * ~ <br /> <br />Executed on ~ - ~ - c¡ 1./- At ) . . By d-..~ Jt ./ 7.L <br />DATE CRYANDS TE SIGNATURE Of CANDIDATtIUt'MnOtOfR <br /> <br />Type or print In Ink. <br /> <br /> <br />~~~e... <br />cOMMmn ADOIIESS (NO. AND STIIIET) <br />~ <br />crrv STATE lIf'COOf A!lEACODEIDAYT..E PHONE <br />~~~ ax:¡. & ~- <br />NAME OF TREASURER <br />:R\(1I...\A.\QJ) 5. (1LþJ Qj,::'" <br />(NO. AND STIIIET) <br /> <br />PERMANENT ADOIIESS Of TllEASUII£R <br /> <br />crrv <br /> <br />~(.::. <br />STATE <br /> <br />AIliA CODEIDAYT..E PHON£ <br /> <br />ZIP CODE <br /> <br />\ , <br /> <br />Executed on <br /> <br />At <br /> <br />CITY AND STATE <br /> <br />DATE <br /> <br />Executed on <br /> <br />At <br /> <br />CITY AND STATE <br /> <br />fOR INfORMATION IllQUIRED TO IE 'IIOVIDED TO YOU 'URSUANT TO THE INfORMATION PIIACTICESACT Of 1'11. SEE INfO!!f!lATION M~IcO!'! CAMPAIGN DISClOSURE PROVfi!QNS Of THE POlmc"l RHORM "CT <br /> <br />DATE <br /> <br />Statement coverS period <br /> <br /> <br />from <br /> <br />4-ß-"'4 <br /> <br />. . <br />> t " <br /> <br /> <br />t. J <br /> <br />through Iø - 30- '4 <br />Date of election If applicable: <br />(Month. Day. Ve.r) <br /> <br />nUG 1Z 3 30 P <br />1x-~~ <br />~ I¡,~" t ~ <br /> <br />'age \ of <br />For Official Use Orily <br /> <br />~ 'i'. \q~4 <br /> <br /> <br />1.0. HUMIEII <br /> <br />NAME Of TREASUREII <br /> <br />CONTROLLED cOMMmn1 <br />0 YES DNO <br /> <br />COMMmEE ADOIIESS <br /> <br />(NO. AND STIIIET) <br /> <br />crrv <br /> <br />STATE <br /> <br />AREA CODEIDAYTIME PHONE <br /> <br />ZIP CODE <br /> <br />COMMmn NAME 11.0. HUM.EII <br /> <br /> <br />NAMI Of TREASURER CONTROlLED COMMITTEE? <br />DYES D NO <br /> <br />cOMMmn AODRESS <br /> <br />(NO. AND STREET) <br /> <br />crrv <br /> <br />STATE <br /> <br />AREA CODEIDAYTIME PHONE <br /> <br />ZIP CODE <br /> <br />AttKh Mklt#ONJI'nform.tlon on ."",OIK'.tely labeled contlnu.tlon sheets. <br /> <br /> <br />By <br /> <br />SIGNATURE Of CANDIDATElOfflCEHOlDER <br /> <br />By <br /> <br />SIGNATUR[ Of CANDIDATEJOffICEHOlD[II <br />