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$11ORI' FORM <br /> <br />Recipient Committee Type or Print In Ink. $1.toment covers perl=~ <br />Campaign Statement~Sho~ Form ~ /~-- <br /> <br />Check one el Ihe following boxes Io Indicile lbo lype of slilement being Illed: )Month, Day, Year) <br /> <br /> ~ Pie elecii~ Statist ~ Oal~ ~ea~[e Po~l-~a~li~at~ Stata~ <br /> ~ ~ a~ual Slal~e~ ~ ~1 Odd-yea( Campaign Re.it <br /> <br /> ~ ~pp~nl~ Pie ~ocl~ ~e~l (Alta~ a ~pletad F~m 495 to I~s statem~l.) <br /> ~ T ef~al~ ~lal~e~ (Allah a c~pleted ~rm 415 Io ~is slatted.) <br /> , Committee I.Iormat]on ~ <br /> <br /> II Commil te elope (c~ct Mgs) h ~is a conuoll~ co--lite=7 ¢ Y~s ~ Ho I~ this ~ =~nm~ co~it~=7 <br /> <br /> III Verification <br /> This commillec has no~ received any conltibutions, cumulative contributions or misccllsocous receipls from a single source totaling $ I00 or morc which must be itemized, and <br /> this commilteo has not mad~ or received loans, and has no accrued cxpenses or outstanding enforceable promises received. <br /> I have used all reasonable diligcanc in preparing this stalemenl. I have reviewed Ihe statement and to lbe best of my knowledge thc information conlained herein is uuc and <br /> <br /> An officeholder, candidale, or slain measure proponent who co~uols a commillee must also verify the campaign stalement. <br /> I have used all reasonable diligence and m the best of my knowledge fhe ueasurer has used all reasonable diligence in preparing Ibis slalement. I have reviewed the stalement <br /> and Io the best of ~ny knowledge lhe information contained herein is true and comldel¢. I cellify under penalty of perjury under the laws of the SLate of California that the <br /> foregoing is flue ~utd CoIreCl. <br /> <br /> Execuled on Al BIt <br /> [xeculed on Al Blt <br /> <br /> Executed o~ Al By <br /> <br /> <br />