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Campaign Statement -- Long Form <br />(Government Code Sections 84200-84216.5) <br />SEE INSTRUCTIONS ON REVERS~ -- <br />Check one of the following boxes to indicate the type of statement being filed: <br />[] Pre-electionStatement [] Semi-annualStatement <br />[] Special Odd-year Cam paign Report <br />[] SuDplementa; Pre-election Statement (Attach a (ompleted Form 495 to this Statement ) <br />[] ?er ruination Statement (At~ach a corn pleted Form 415 to this statement.) <br />I <br />Committee <br />Information <br /> II <br /> Primarily Formed Committee (See definition on reverse.) <br /> List names of office.holder(s) or candidate{s) for Which <br />NAME OF COMMITTEE <br /> ~ L ~-~ ~ '~ ~ this committee is primarily formed, c.~c~o~ <br /> ~ ~ C'~ ~ ~) ~ ~ ~ ~C~ NAMEOFCANOIOATE(S)O~OfFICEHOLOEI~S) Of F~CESOUGHTORHELO <br /> NAME OF TREASURER ~ <br /> (Check Boxes) See definitions and impoaant info~ation on revere. <br /> Is this a sponsored committee? .................. <br /> <br />Is this a broad based political committee? ......... ~ yes ~ ~o Attach additional info~ation on appropriately la~l~ continuation sheets. <br />III Verification <br />I hav~ u~d aU r~*~onabl~ dili~n~ in pr~parin~ thi~ ~tat~ment. I hav~ r~view~d th~ ~t~tem~nt ~nd to th~ b~*t o~ m~ knowl~d~ th~ information rontain~d <br />h~r~in and in th~ *tt*rh*d ~rh~dul~ i~ true *nd rompl~te. <br />Executed on ~ DATE At <br />Executed on. At <br /> <br /> State of Calif m'nla Fai; Political P;actices Commission <br /> <br /> <br />