Laserfiche WebLink
Cand idate, Type m print in ink. COVER PAGE- LONG FORM <br />Officeholder, <br />and Controlled Committee Statement covers period Date Stamp <br />Campaign Statement -- Long Form <br />(Government Code Sections 84200-84218.5) <br /> /q <br />SEE INSTRUCTIONS ON REVERSE through ~ ~ <br /> <br />Check one of the followin~ boxes to indicate the type of statement boln~ flied: Date of election if E <br /> Pre-election Statement (Month, Day, Year) For Official Use Only <br /> Supplemental Pre-election Statement (Attach a completed Form 4gS to this statement.) <br /> Special Odd-Year CJmpaign Report <br /> Semi-annual Statement i/'~ <br /> Termination Statement (Attach i completed Form 415 to this statement.) <br /> <br /> In4 lis Statement com/n/IYees not/nc/uded In Ch/J coMo//dated statansent I ! are contro//e~ by yo~ a~ld an~ <br /> NAME Of OFflCEHOLD~I~ OR CAI~ATE <br /> comm/Itees of wh/~h you have knowledge that are pdmar//y formed to rece/ve cont~/b~/om <br /> ,j --- ,.o.-,, <br /> RESIMNTiAL (~ I ADOMSS · / MO. AND STREET) ' CONTROLLED COldMn~Ell <br /> <br /> cJ ood CA-ClqO( 5 <br /> COMMITTEE NAME -- I ~ [ .~ , ,4// I ILO. mJMml ClW - , ~,Ji _~l~r__RK- --" Z~ ~r.4Nx AI~A COOfJOAYTidE mom <br /> I <br /> I <br /> ' <br /> <br /> I~RMANE _MT AM)a~ss 4~ . ,TIIE_~. I /.), MO. ~ STREET) C/TV STATE ZiP COME AREA COMJDAYTIME PHONE <br />III Verification ' ~ ~ ' <br /> <br /> An offkeholder m (jndidnte who u)ntrol~ I committee ma~t elso verify the LOmpel~n ~tatement. I have used all reasonable diligence and to the best of my knowledge the treasurer his used ill <br /> reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained~h,herein I~nd in the)i~tached schedules is true <br /> complete. I certify ~mcler pqnalty of perjury un,er th/a laws of ~e St_nt9 of Celiforn. ii that the foregoing is true and co~./// / ~,// / <br /> <br /> -L ~Tt ' ciTY AND'S(A" ' ./ ~G~A~E of CAWDATE~C~~_.~ <br /> Executed on At By ff / <br /> DATE CiTy AND STATE SIGNATURE Of CANDIDATE/OfFICEHOLDER <br /> <br /> Executed on. At By <br /> DATE CiTY AND STATE SIGNAIURE Of CANDIDATE/Of~ICEflO~LDE A <br /> <br /> FOR INFOIMATION REQUM~D TO IE PROVI(~D TO YOU PURSUANT TO THE INFORMATION PRACTICES AC10~ !177, SEE INF~)RMATI~)I~I MANUAL ON CAMPAIGN DISCLOSURE PR(~VIS#~tS Of TH~ R(XITICA~. REFOIUd A~... <br /> <br /> <br />