Laserfiche WebLink
COVER PAGE <br /> Recipient Committee -� ` }oate stamP �L • - , <br /> • 1 <br /> Campaign Statement <br /> Cover Page Statement covers period Date of Election if applicable Page 1 of 11 <br /> �''�� � � ���� � <br /> from <br /> 10/18/2015 "`�" '"� � ForOfficialUseOnly <br /> 11/03/2015 ' <br /> throUgh 12/02/2015 (MOnth, Day, Yeaz) <br /> 1. Type of Recipient Committee 2. Type of Statemeflt = ` <br /> � Officeholder,Candidate Controlled Committee � Primarily Formed Ballot Measure � Pre-election Statement � Quarterly Statement <br /> � State Candidate Election Committee Committee � Semi-Annual Statement � Specia l O d d-Year S ta tement <br /> 0 Reca�� � Controlled � Termination Statement � Supplemental Pre-election <br /> � General Purpose Committee � Sponsored ❑ Amendment Statement-Attach Form 495 <br /> G` Sponsored <br /> Small Contributor Committee Primarily Formed Candidate/ <br /> � Oificeholder Committee <br /> � Political Party/Central Committee <br /> I.D.Number 1377423 <br /> 3. Committee Information Treasurer(s) <br /> COMMITTTEE NAME NAME OF TREASURER <br /> Rosanne Foust for City Council 2015 Russell Miller <br /> STREET ADDRESS <br /> <br /> STREET ADDRESS(NO PO BOX) CITY STATE ZIP CODE AREA CODE/PHONE <br /> Burlingame CA 94010 <br /> CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY <br /> Redwood City CA 94062 Kirk Alan Pessner <br /> MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS <br /> <br /> CITY STATE ZIP CODE CITY STATE ZIP CODE AREA CODE/PHONE <br /> Burlingame CA 94010 <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 of my ledge the information contained herein is true and <br /> complete. I certify under penalty of perjury under the laws of the Sta alifornia th t f,orego' is�-ue nd correct. <br /> Executed on 12/ 1 0 /15 By �l <br /> ^�' SI RE OF T A URER OR ASSISTANT TREASURER <br /> � � "� <br /> Executed on 12/ � /15 By i / V� <br /> SIGNATURE OF CONTROLLING OFFIC HOLDER,CA DIDATE,STATE MEASURE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR <br /> Executed on By _ <br /> SIGNATURE Of CONTROLLING OFFICEHOLDER,CANDIDATE STATE MEASURE PROPONENT <br /> Executed on By <br /> SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,STATE MEASURE PROPONFFI�I,�C Form 460-January/05 <br /> State of Califomia/SI <br />