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COVERPAGE <br /> R@Clpl@Ilt C.Otllllll�@@ Type or print in ink. � �� <br /> Campaign Statement ; � �' '-��-����'�`��� ��� � � • � <br /> CoverPage � OCT 'i! ' <br /> (Government Code Sections 84200-84216.5) 2 3 2003 , <br /> Statement covers period Date of election it applicab . ' page ( of1�__ <br /> 9/21I03 (Month, Day, Year) p ITY ti��n'�'.�`!vi)t;� ��ITY <br /> from �����=�;.,1��,� For Official Use Only <br /> i_ �..�_..m._. , .... _,...�- <br /> SEE INSTRUCTIONS ON REVERSE through ��I��,03 �y4'�� <br /> 1. Type of Recipient Committee: A��comm�nees-comp�ete Parts�,z,s,a�a a. 2. Type of Statement: <br /> (� Officeholder,Candidate Controlled Committee ❑ Ballot Measure Committee � Preelection Statement � Quarterly Statement <br /> Q State Candidate Election Committee Q Primarily Formed ❑ Semi-annual Statement � Special Odd-Year RepoA <br /> Q Recall Q Controlled � Termination Statement ❑ Supplemental Preelection <br /> (AlsoCompletePaRS) Q Sponsored � Amendment(Explain below) Statement-Ariach Form 495 <br /> (Also Complete Part 6) <br /> ❑ General Purpose Committee <br /> Q Sponsored � Primarily Formed Candidate/ <br /> Q Small ContributorCommittee Officeholder Committee <br /> Q Political Party/Central Committee (A�soCompletePaR7) <br /> 3. Committee Information I.D. NUMBER Treasurer(s) <br /> 12�31 <br /> COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> 1 �.�� S Cl.,p►11P� — <br /> MAILING ADDRESS <br /> Qn�uN� �'a�sT Fa2 Cr['�l �c�,tl.. <br /> STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE <br /> �a� L�rc�l �► 9a�L ��� � - <br /> CITY STATE ZIP CODE AREA CODEIPHONE NAME OF ASSISTANT TREAS RER, IF ANY <br /> 'Rt�c•x �t�l C.A► � 94tXo2 ([ uU►. <br /> MAILING ADDRESS (IF DIFFER NTJ NO.AND STREET OR P.O. BOX MAILING ADDRESS <br /> CITY �� STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODEIPHONE <br /> OPTIONAL FAX/ E-MAIL ADDRESS OPTIONAL: FAX I E-MAIL ADDRESS <br /> 4. Verification <br /> I have used all reasonable diligence in preparing and reviewing ihis statement and to the best of knowled the' form tion contained herein and in lhe atiached schedules is true and complete. I <br /> certify under penalty of perjury under the laws of the State of California that the foregoing i cor <br /> � <br /> Executed on���2��� BY � <br /> Dale ignaWr reasurerorASSisfa Treasurer <br /> EXeCUled on D O BY Signat reofCOntrdlin �dder,Cantli ale,S�ateMe e roponentorResponsibleOtficerdSponsa <br /> Da�e 9 <br /> Executed on BY <br /> Date Signature of Controlling Officehdtler,Candidate,State Meawre Propment <br /> Executed on BY FPPC Form 460(June/01) <br /> Date SignatureolConrrollingOfficehdder.CarWidate.SlateMeasureProponent FPPCToII-FreeHelpline:86WASK-FPPC <br /> State of California <br />