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<br />SEE INSTRUCTIONS ON REVERSE <br /> <br />Statement covers period <br />from 7/' /ð2. <br /> <br />through l;?lZ'Ioz. <br /> <br />Date of election if applicable <br />(Month, Day, Year) <br /> <br /> <br />Foc Official Use Only <br /> <br />Recipient Committee <br />Campaign Statement <br />Cover Page <br />(Government Code Seclions 84200-84216.5) <br /> <br />Type or print in ink. <br /> <br />1. Type of Recipient Committee: All Committees - Complete Parts " 2, 3, and 4. <br /> <br />00 Officeholder, Candidate Controlled Committee <br />0 State Candidate Election Committee <br />0 Recall <br />(AlwCompl."P"'5) <br /> <br />0 Ballot Measure Committee <br />0 Primarily Formed <br />0 Controlled <br />0 Sponsored <br />(Alw Comp"" P'rl6) <br /> <br />2. Type of Statement: <br />0 Preelection Statement <br />0 Semi-annual Statement <br />0 Termination Statement <br />0 Amendment (Explain below) <br /> <br />0 Quarterly Statement <br />0 Special Odd-Year Report <br />0 Supplemental Preeleclion <br />Statement - Attach Form 495 <br /> <br />0 General Purpose Committee <br />0 Sponsored <br />0 Small Contributor Committee <br />0 Political Party)Central Committee <br /> <br />0 Primarily Formed Candidatel <br />Officeholder Committee <br />(AlwComplel,P,rl7) <br /> <br />3. Committee Information <br /> <br />1.0. NUMBER <br />41494 <br /> <br />Treasurer(s) <br /> <br />COMMITTEE NAME lOR CANDIOATE'S NAME IF NO COMMITTEE) <br /> <br />NAME OF TREASURER <br />lØd/Ih.t!P $. ~~ <br />MAILING AOORESS <br />$.4ut:T <br />~~ <br />NAME OF ASSISTANT TREASURER, IF ANY <br /> <br />STATE <br /> <br />ZIP CODE <br /> <br />AREA CODE/PHONE <br /> <br />O/~"'¡¿ JØUhI/W ~ &.. &N4'L <br />STREET ADDRESS (NO P.O. BOX) <br /> <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />~~ {!;rý t!A 94a2- <br />MAILING ADDRESS (IF OIFFEREm) NO. AND STREET OR P.O. BOX <br /> <br />CITY <br /> <br />MAILING ADDRESS <br /> <br />CITY <br /> <br />STATE <br /> <br />ZIP CODE <br /> <br />AREA CODE/PHONE <br /> <br />STATE <br /> <br />ZIP CODE <br /> <br />AREA CODE/PHONE <br /> <br />CITY <br /> <br />OPTIONAL' FAX / E-MAIL ADDRESS <br /> <br />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 knowledge the information contained herein and in the attached schedules is true and complete. I <br />certify under penalty of pe~ury under the laws of the State of California that the foreg~ nd c <br /> <br />Executedon ,I.sa/a] By ~h <br />Executed on "í""'¡tÍ$ 0,.. <br />l~ 0,.. By <br /> <br />D'te <br /> <br /> <br />Si,"',"reofC~,""i""Offiœh",~,Ca""i""te,S"teMoo,"rePropon'"t <br /> <br />Executed on <br /> <br />By <br /> <br />Executed on <br /> <br />Date <br /> <br />By <br /> <br />Slg"""reofCoo,""I""Offiœ""d~,Ca",,i""",S""M","rnPropon'cl <br /> <br />FPPC Form 4GO (June/OI) <br />FPPC Toll-Free Helpline' .G6fASK-FPPC <br />State of California <br />