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<br /> <br />Type or print in Ink. <br /> <br />- <br /> <br />cOMMmEUDO"'" ~JHo.ANDST"EJj <br />,-"5kJJ1¿; fÁP:, A~'1::::j <br />CITY ST A" <br /> <br />ZIP COD< <br /> <br />AllfACDOflDAYT..E- <br /> <br />NAME Of TREASURER <br />'If Y2.G/IIJA- ~ . <br />""'ANENT _"Of TOILASU'" <br />\ ¿ ~ - - -~- <br />CITY"" STA" ZIPC... AllfACDOfIDAYT..E- <br />~~ @.ny ~ 9"Ia?¿ "JjA- <br /> <br /> NO. AND ST"") <br /> <br />COVER PAGE - LONG FORM <br /> <br />from <br /> <br /> <br />Date Stamp <br /> <br />through ~ <br /> <br />Dlte of election H Ipplkll¡le: <br />(Month. DIY. V..r' <br /> <br />ther Committees Not Included In this Statement: LIst any otMr <br />committee. not Included In this consoIldlted statement tINIt Ire controlled by you Ind any <br />committee. olwftlch you Nile knowledge tINIt Ire prtmlrlly foTmed to receive contrIbutions <br />or to mike expenditure. on be""" 01 your CI~. <br />COMMm.. NAME I'.D. NUMI" <br /> <br /> <br />.....EOFTOILASU... CONTIIOlLEDCOMMmm <br />Om DNO <br /> <br />COMMm.. A""" <br /> <br />(ND.ANDST"ET) <br /> <br />CITY <br /> <br />STA" <br /> <br />Zl'CODE <br /> <br />A....coDEIDAynME- <br /> <br />COMMm.. NAME I'.D~ NUM"" <br /> <br /> <br />-OfTOILA....." CONTIIOlLEDCOMMmm <br />Om P NO <br /> <br />COM"""E _IS <br /> <br /> NO. AND SToiiTJ <br /> <br />.." <br /> <br />CITY <br /> <br />STA" <br /> <br />Zll'C'" <br /> <br />MEA CODEIDAYTlME- <br /> <br />AItIch _one' information on I"",oprlately libeled continuation sheets. <br /> <br /> <br />"n officeholder or undldlte who controls I committea must also verify the campaign stltoment~ I hive used III reasonable diligence and to the best of my knowledge the treasurer his used III <br />reasonlble diligence in preparing this stltement. I heve reviewed the stltement and to the best of my knowledge the infor~n C9ßtlinecj.lji(.8iff alJ'!1h ~ttached schedules is true and <br />complete. I certify %~nllty of perjury un~he laws of the State ofCalifor~ that the foregoing is true and torr, <br />Executed on I. At ~Jlm? ~d 'A--- By <br /> <br />Executed on <br /> <br /> <br />At <br /> <br />DATE <br /> <br />CITY AND STA" <br /> <br />Executed on <br /> <br />At <br /> <br />DATE <br /> <br />CITY AND STA" <br /> <br />rD"NrOOMAT"," "QUI"D TO IE P"OVIDED TO YOU PUIISUANT TD THE INF"""T"," POACTICESACT OF IOTT. ""NFOIIMAnON MANUAL ""CAMPAIGN DISCLOSU" "OVI5I""S OF THE POlITICAL"FO'" AQ <br /> <br /><..,. .<r."'.-.'. <.,- ft.""..' ft.. ,"m -.__In'.. <br /> <br /> <br />By <br /> <br />SIGNATU" OF CANDIDATEIOfFICEHOlD.. <br /> <br />By <br /> <br />5IGNATU.. OF CANDIDA"IOfFICEH D" <br />