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SIIORT FORM <br />Recipient Committee Type or Print In Ink. Statement oovar~ peri- OateStamp <br />Campaign Statement -- Short Form ////'/ <br /> <br />musl~ilemiz~,havenot~eceivedorm~elo~s,~dhave~oum~d~gaccmedex~mesor through 0 1992 '" A <br />e~orc~ble promises r~eiv~. Dale el Election <br /> If appllcablet <br />Cheek o~ of tho Iollowl~ boxes to Indicate tho type of statement being flied: IMonth, Day, Year) C~_~ U J <br /> ~ P~s-elecii~ Stalest ~ Ballol Meagre Posl-quali[icatbn Slate~n[ <br /> ~ Semi-amua[ Slal~ent ~ ~ec~l Odd-yem Campaign Re~ <br /> ~ ~pple~nl~ Pm-elecli~ ~alem~[ (Alla~ a ~pleled Form 495 te [his ~lalem~l.) <br /> ~ Terra,alan Slal~enl (Allach a ~plel~ ~m 4 ~ 5 lo Ihi~ ~lat~en[.) <br /> <br /> I Committee Info~ation <br /> II CommitteeType (che&M~s) Is ~isaconaoll~co~it~e? DYes ONo Is~isas~mr~co~itme? DYes DNo ls~isabroadb~co~itme? ~Yes DNo <br /> <br /> III Verification <br /> This cotnmittee has no[ received any contributions, cumulative contributions or miscellaneous receipts from a single source lolaliflg $ I O0 or more which must b~ itemized, and <br /> this committee has not made or received loans, and has no accrued expenses or outslanding enforceable promises received. <br /> I have used all reasonable diligence ia preparing this stalement. I have reviewed the statement and lo the best of my know~edge the i~rmadon contained herein is tree and <br /> under penalty of perjury under the laws of the State of California that the foregoi~nd ~j~r. e~. ~'~ <br /> complete. <br /> I <br /> <br /> An officeholder, candidate, or state measure proponent who controls a committee must also verify the campaign slatemenL <br /> <br /> I have used all reasonable diligence and I~ the best of my knowledge the treasurer has used all reasonable diligence in preparing this statement. ! have reviewed the statement <br /> and to the best of my knowledge the information contained herein is tree and complele. 1 certify under penalty of perjury under the laws of the Stale of California that Ihe <br /> foregoing is true and correct. <br /> <br /> Executed on Al By <br /> <br /> Execuled on At By <br /> <br /> Executed on Al By. <br /> CUY AND SIA1E SIGNAIUnL or orrlCEp~OtDEn, C^taI~L~gE. O~l mceo~lrN l <br /> <br /> <br />