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�V�u�vu�v�u r r��u��.��ur.• <br /> Recipient Committee <br /> Amendment <br /> �Check box it an Amendment <br /> and enter I.D.number: <br /> File original end one copy wNh: <br /> Secrelary ot State <br /> PoliHcal Relorm Division <br /> P.O.Box 7467 <br /> Sacramento,CA 95812-1467 <br /> County and Ciry Committeee fite a copy <br /> Local liling oflicer who will receive tha original <br /> disclosure statements. • <br /> INSTAUCTIONS ON REVERSE <br /> Type or print in Ink <br /> 1. Committee Information <br /> Date qualified as committee_�� �Not yet qualified <br /> NAMEOFCOMMITfEE p <br /> Cornm�t�e� i-o � lecf �arloarct. ( �ev�r.e <br /> ADDRESSOFCOMMITfEE NO.ANDS7REET(NOP.O.BOX) <br /> NUMBER <br /> � ICOUNTYOFDpAICILE <br /> SC.-v� Iti1a�-E-e0 <br /> CI7Y STATE ZIPCODE � AFEACODFiPFiONENUMBER <br /> OPr10NAL• AREACODE/FAXNUMBER OPfIONAL• E-MAILADORESS <br /> — — _: <br /> � � ^,i <br /> _- _ _- - '� I i; <br /> ': JUL 2 ? 1999 <br /> �_i ', i� <br /> ,i?Y OF R��=",'.J�;:�C CIl Y <br /> 2. Treasurer and Other Principal <br /> R ��h�;�d. �G h; s+�d <br /> NAME OF TREASURER . <br /> <br /> MAIIINC�ADDRESS <br /> � zd �aod c ,�y , c� �ya�Z <br /> cm <br /> S7ATE ZIPCODE <br /> NAME AND POSITION OF OTHER PRINCIPAI OFFICER(SJ,IF APPIICABLE <br /> MRILING ADDRESS <br /> CITV STAiE ZIPCODE AREACODEIDAVTIAAEPHONE <br /> � � <br /> OPf10NAL• AREACODFJFAXNUM2ER OPIIONAL•' ,E-MA`'iIADDRESS <br /> <br /> <br /> �� � <br /> 3. Verification <br /> I have used all reasonable diligence in preparing this statement and to the best of <br /> under penaity of perjury under the laws of the State of Califomia that the foregoi <br /> Executed on(n ' �� � /� / By � <br /> DAT <br /> Executed on � -� ��" �� By A.� <br /> DATE <br /> Executed on <br /> the iniormation conlained herein is true and compiete. I certify <br /> and <br /> ey <br /> SIGNAiURE OF CONTROILING OFFICEHOLDER.CANDIDAIE.ORST�TE MEASUFE FROPW�EN� <br /> Exec�ted on By <br /> DATE SIGNATURE OF CONTROLLING OFFICEHOLOER,C�NDIWTE,OR STATE MEASUPE PROPONEM <br /> FORINfOHMATI0NRE0UIREDTOBEPROVIDEDTOYOUVURSVANTTOTHEINFORMATIONPHACTiCES/�CTOF1971.5EE OR• hMANLAION M,PAI NOI� IO��R F`RO`A�IONaOFTM P m ��REFORNACT. <br /> FPPC Form 910 (2l98) <br /> �. � . For Teehnieal Aeeletenee: 916/322-5660 <br />