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, ~ COVER PAGE --LONG FORM <br />Campaign Statement -- Long Form <br />~ ~ P~el~ ~at~ (~ a ~t~ F~m 495 to this star--nE,) <br />~ Tm~ ~ (~ · ~ F~m 415 to t~ stat~t.) <br />I ~liee Inlomflon II Pr~dly Fowd ~ttee (~e definition on reverse.) <br />List gms ol officeholder(s) or can~date(t) lot which this <br />I Ve~citlon <br /> <br /> <br />