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Recipient Committee COVER PAGE <br /> Type or print in ink <br /> Campaign Statement a amp CA I NIA 460 <br /> RECEIVE FORM <br /> Cover Page "! <br /> (Government Code Sections 84200 84216 5) 1 of 5 <br /> Statement covers period Date of election if applicl ble: JAN 2 6 2011 Page <br /> from 7/1/10 (Month, Day,Year) F. Official Use Only <br /> 12/31/10 <br /> SEE INSTRUCT ONS ON REVERSE CITY OF REDWOOD CITY <br /> through CITY CLERK <br /> 1 Type of Recipient Committee: A Committees Complete Parts 1,2,3,and 4 2 Type of Statement: ` <br /> ® Officeho der,Candidate Contro ed Committee ❑ Primari y Formed Ba lot Measure ❑ Preelection Statement ❑ Quarterly Statement <br /> Q State Candidate E ection Committee Committee Semi annua Statement ❑ Special Odd-Year Report <br /> Q Reca 0 Contro ed <br /> (Also Complete Part 5) Q Sponsored ❑ Termination Statement ❑ Supplemental Preelection <br /> (A so file a Form 410 Termination) Statement-Attach Form 495 <br /> (Also Complete Part 6) <br /> ❑ Genera Purpose Committee 0 Amendment(Exp'�ain be ow) <br /> Q Sponsored ❑ Primari y Formed Candidate/ <br /> Q Smal Contributor Committee Officeho der Committee <br /> Q Po Rica Party/Centra Committee (Also Complete Part <br /> 7) <br /> 3 Committee nformation 0 NUMBER Treasurer(s) <br /> 1313693 <br /> COMM TTEE NAME(OR CANDIDATE'S NAME F NO COMM TTEE) NAME OF TREASURER <br /> JOHN SEYBERT FOR CITY COUNCIL 2009 RICHARD S.CLAIRE <br /> MAILING ADDRESS <br /> SAME <br /> STREET ADDRESS (NO PO BOX) C TY STATE ZIP CODE AREA CODE/PHONE <br /> <br /> C TY STATE Z P CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, F ANY <br /> REDWOOD CITY CA 94062 <br /> MAIL NG ADDRESS (F DIFFERENT)NO AND STREET OR P 0 BOX MAILING ADDRESS <br /> CITY STATE ZIP CODE AREA CODE/PHONE C TY STATE ZIP CODE AREA CODE/PHONE <br /> OPT ONAL: FAX/E MA L ADDRESS OPT ONAL: FAX/E MAIL ADDRESS <br /> 4 Verification • <br /> have used a reasonab e di.igence in preparing and reviewing this statement and to the best of my know ed_a the information contained herein and in the attached schedules is true and complete. i certify <br /> under pena ty of perjury under the aws of the State of Ca ifornia that the foregoing is true and, ec <br /> Executed on 1-21-2011 By / ,7Al •A.. , �. <br /> Date <br /> Executed on i`Z — / r �!�Milli�� <br /> Date Signalu'•f ontroling0 hol•",Cs •7 47.le Measure Proponent orResponsibtaOfMder Spot <br /> Executed on By <br /> Date Signature of Contro Ping Officeholder,Candidate,State Measure Proponent <br /> Executed on By <br /> Date Signature of Contro ling Officeholder,Candidate,State Measure Proponent FPPC Form 480(January/05) <br /> FPPC Toil-Free Helpline:884IA$K-FPPC(88812753772) <br /> State of California <br /> l <br />