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Reci�ient Cammittee <br /> Gampaign Statement <br /> Cover Page <br /> (Govemment Code Sectiens 84200-84218..`,j <br /> Type or prinE in ink. <br /> Statement cavers periad Date of eiection if applicable: <br /> 1/1/05 i�cnth, Day,Yearj <br /> from --—------------------------- <br /> SE��NSTRUt;TIONSOPJ REV�RSC � t��a��� 6/30/05 <br /> 'I. Ty�'3@ bf R@CE�fiGht GOtTII'tl1�8i': Ali Gommitiees—Complete Parts 1,2,3,and 4. <br /> � Of�iceholder,Candidate Controlled CammitEee ❑ Ballat�,qeasure Cummittee <br /> (j State Carsdidate Eie�tion Committee �; Primarily Formed <br /> �j RecalE �; Controlled <br /> t�,;svccv,;u�raP�,rS� �; Sponsored <br /> /A;sc Compefe Part Ej <br /> ❑ Ganeral Purpose Committes <br /> C Spunsarad <br /> Q SmallConEtibuiarCommittee <br /> C Po3iticalParty/CentralCammitkse <br /> �'; RrimarilyFormedCandidate! <br /> OfFiceholder Gommittee <br /> (4!se comp!ere Psvt Tj <br /> 3. Committc�e Information ° "`�}'�E;�-� <br /> 1255762 <br /> COM�AITT�E NAM�(uR CfiNDIDATE'S Nr�.PAE IF ��ir CGfvS61ITTEE; <br /> Committee to Elect lan Bain <br /> S?�REcI2'f ADDREcSS (r;0 F.O F30X) <br /> <br /> CI?Y ST,TE Z!P CCCE AR-A CCD�lPHONE <br /> Redwood City CA 94061 <br /> MAILING l�DDRESS i;F DIFFERE\Tl tiu. A?�C STREET OR °.Q BOX <br /> �I?Y <br /> sT,TE Z�P CGCE AR_A .r,G7�lPHONE <br /> 11/4/03 <br /> z. T�/pe of Statement: <br /> ❑ Preeler.tian Statement <br /> � Semi-anniialStetement <br /> ❑ Termination Stafement <br /> ❑ Amendment{Er.plain beEov,r) <br /> Treas u rer(s) <br /> Catc S:amp <br /> GOVER RAGE <br /> page � 04 2 <br /> For ONiral Usz ��mly <br /> ❑ Quarteriy Statement <br /> (—J Special t�dd-Year Report <br /> (�_] Supplernental Preelection <br /> StatemenF-A4tach Form 49� <br /> NFME:OF TRE:ASUR1=:12 <br /> Nancy Bain <br /> WSRILING ,UDkE55 <br /> <br /> CfiY SfP:TE: 71P COD6�. .4RE=A COL'E:JFNO";L-: <br /> Redwood City CA 94061 <br /> NAR4E=OF�ASSISTP.p;�� 1-RL:AEUI�E=R, IF�.4NY <br /> F�FILIiJG ADD <br /> �ITY °•TAT� ZIP CODE ARE.h CbCE/FHG�iE <br /> OP7iOtiAl_: F�AX!E=-?.APJL.4D6RE:SS OFTIp�J:�.L �,4X!�-PA.41L AC�DFE55 <br /> ian@ianbain.com <br /> 4. Verification <br /> I have used all reascnab3e diligence in preparing ani revi�wing this statement and to fhe besi oi my kn�wledge the infcrmation contained herein and in the attached schedules is true and complete. E <br /> certify under psnalty of perjury under th� iaws of the State of CaEifornia thak the feregaing is true�e+�orrect. _ <br /> G�eouted or; 8/1/05 <br /> Dztc <br /> �cecuted��r. <br /> 8/1/05 <br /> r,=� <br /> E�cecuted UI? <br /> Cate <br /> �,b' <br /> Bv <br /> B'v <br /> � Signa�ire of r_.ontrolli?+g Offir_ebkier,Cancl�laie,State Measure Froporr:f <br /> Exzr,uted or. E3y <br /> Cb[e 6iqna;ure of Gonh�clliro;Xiicerokfer,Cariditla:e,Shate M�asu�t Frcpone:a FPPC FOfm 46Q(J une/09) <br /> FPPG TolE-Free HelpEina:8fiS/A8K-FPPC <br /> State of California <br />