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Recipient Committee T COVER PAGE <br /> ype or print in ink. Date Stamp _ <br /> Campaign Statement � � � • 1 <br /> Cover Page <br /> (Govemment Code Sections 84200-84216.5) ` i � � <br /> Statement cove s period Date of election if applicable: Page of J �? <br /> 2Q i� (Month, Day,Year) � �; � f";`� For Official Use Only <br /> from - <br /> SEE INSTRUCTIONS ON REVERSE through 1 2' 4�� J � O�� <br /> 1. Type of Recipient Committee: no commncees-compi�ce Pa►��,z,a,and 4. Z. Type of Statemenf: _ <br /> � O�ceholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure �Preelection Statement � G2uarterly Statement <br /> ��Q State Candidate Election Committee Committee Semi-annual Statement � Special Odd-Year Report <br /> � Recall Q Controlled Termination Statement <br /> ❑ ❑ Supplemental Preelection <br /> (AlsoCompletePaRSJ � Sponsored (Also file a Forrn 410 Tertnination) Statement-Attach Form 495 <br /> (Also Complete Part 6) <br /> ❑ General Purpose Committee ❑ Amendment(Explain below) <br /> Q Sponsored � Primarily Formed Candidate/ <br /> Q Small Contributor Committee Officeholder Committee <br /> Q PoliticalParty/CentralCommittee (AlsoCompletePart7) <br /> 3. Committee Information I.D. NUMBER ( �f,C � � Treasurer(s) <br /> C�' <br /> COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> 1�V lCi� ���� 1 CV U�Cl � p`I.OI � MAILING ADDRES�r'� `�' <br /> v � <br /> STREET ADDRESS(NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE <br /> ' ��- �a.�..Sase. C'�I- °����2 <br /> CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY <br /> Red.u,�o����� C.� q4f?6� ��� <br /> MAILING ADDRESS(IF DIFFERE T) NO.AND STREET OR P.O. BOX MAILING ADDRESS <br /> CITY STATE ZIP CODE AREA CODElPHONE CITY STATE ZIP CODE AREA CODE/PHONE <br /> OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS <br /> <br /> 4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best o my knowledge the information contained herein and in the attached schedules is true and complete. I certify <br /> under penalty of perjurv���Pr}�^� •••--`the State of California that the foregoing is tr nd c r�ect. , <br /> Executed on � ���` By ' " �� <br /> � pate Signa ofTreas rorAssistantTreasurer <br /> Executed on � �� �o'� By <br /> Date Si -ot ntrollingOtficeh der,Candidate, teMeasureProporrentorResponsiMeOficerofSponsor <br /> Executed on By <br /> Date SignaNre ofControlling Officehdtler,Candidate,State Measure Pmponent <br /> Executed on By <br /> Date Si9nalure ofControlling Olficehdtler,Candidate,State Measure Proponent <br /> FPPC Form 460(January105) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772� <br /> State of California <br />