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, <br /> Reci ientCommittee � CO�q'� <br /> Ca paign Statement Type or print in ink. D �((��;��T�L , ���� , � • � <br /> ���� <br /> CoverPage <br /> (Govemment Cade Sedions 84200-84216.5) FEB 0 2 2004 • <br /> Statement covers period Date of electlon if applicab � 9 <br /> 10/18/03 (Month, Day,Year) age of <br /> from CITY OCITY CL ROD CIT For orr��i u�omy <br /> SEEINSTRUCTIONS ON REVERSE thfOUgh <br /> 12/31l03 11/4/03 <br /> 7. Type of Recipient Committee: nn comminees-comae�e aares�,z,a,ena a. 2. Type of Statement: <br /> � Officeholder,Candidate Controlled Committee ❑ Balbt Measure Committee ❑ Preeledion Statement � Quarterly Statement <br /> Q State Candidate Election Committee �Primarily Formed � Semi-annual Statement � Special Odd-Year Report <br /> Q Recall Q Controlled ❑ Termination Statement � Supplemental Preeledion <br /> (AlsoComplefaPert5) Q Sponsaed <br /> (AfsaComplelePat6J ❑ Amendment(Explain below) Statement-Attach Form 495 <br /> ❑ General Purpose Committee <br /> � Sponsored � Primarily Formed Candidate/ <br /> Q Small ConVibutor Committee Officehdder Committee <br /> Q PoldicatParty/CenValCommittee �A������P��� <br /> 3. Committee Information I.D. NUMBER Treasurer(s) <br /> 1255762 <br /> COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMIiTEE) NAME OF TREASURER <br /> Committee to Elect lan Bain Nancy Bain <br /> MAILING ADDRESS <br /> <br /> STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODElPHONE <br /> Redwood City CA 94063 <br /> CITY STATE ZIP CODE AREA CODEIPHONE NAME OF ASS�STANT TREASURER, IF ANY <br /> Redwood City CA 94063 <br /> MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O. BOX MAILING ADDRESS <br /> CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE <br /> OPTIONAL: FAX I E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS <br /> ian@ianbain.com <br /> 4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the infortnation contained herein and in the attached schedules is true and complete. I <br /> certify under penalry of perjury under the laws of the State of California that the foregoing is true and corted. <br /> exeatedon 1/30/03 BY �7�.r�/ ` <br /> Dab SignaW� rerorHSSistantTreasurer <br /> Exewled on 1/30/03 BY � ��—yo��C�J <br /> Dab SlgnaMe of Controlln9 le.S�ate Maasure Propanerku Respons�le OlAcerdSporrsa <br /> Executedon � BY �`y������.���,����rePmporient <br /> Executedon � BY Siyryprea{CamaAhgoRkalwlder,CaMWate,Sta�MeasurePropa�ent FPPCFwm460(JUne/Ot) <br /> fPPC Toll-Free Helpline:8661ASK-FPPC <br /> State oi CalNomia <br />