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. _ COVER PAGE <br /> Recipient ient Committee Date Stamp <br /> Type or print in ink. <br /> Campaign Statement CALIFORNIA 460 <br /> 1 �p -� FORM <br /> Cover Page B1 u if <br /> (Government Code Sections 84200-84216.5) page 1 of 11 <br /> Statement covers period Date of election if applicably I JAN 2 7 2010 -� <br /> 10/18/09 (Month, Day,Year) .•••� For Official Use Only <br /> from CITY OF REDWOOD CITY <br /> SEE INSTRUCTIONS ON REVERSE through 12/31/09 <br /> 11/3/09 CLERK <br /> 1. Type of Recipient Committee: All Committees—Complete Parts 1,2,3,and 4. 2. Type of Statement: <br /> ® Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement <br /> Q State Candidate Election Committee Committee 1211 Semi-annual Statement ❑ Special Odd-Year Report <br /> O Recall 0 Controlled ❑ Termination Statement ❑ Supplemental Preelection <br /> (Also Complete Part 5) 0 Sponsored Also file a Form 410 Termination)) Statement-Attach Form 495 <br /> (Also Complete Part 6) <br /> ❑ General Purpose Committee ❑ Amendment(Explain below) <br /> Q Sponsored ❑ Primarily Formed Candidate/ <br /> Q Small Contributor Committee Officeholder Committee <br /> Q Political Party/Central Committee (Also Complete Part 7) <br /> 3. Committee Information I.D. NUMBER Treasurer(s) <br /> _ 1313963 <br /> COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> JOHN SEYBERT FOR CITY COUNCIL 2009 RICHARD S. CLAIRE <br /> MAILING ADDRESS <br /> SAME <br /> STREET ADDRESS(NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE <br /> <br /> CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY <br /> REDWOOD CITY CA 94062 <br /> MAILING ADDRESS(IF DIFFERENT) NO.AND STREET OR P.O. BOX MAILING ADDRESS <br /> CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE <br /> OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS <br /> 4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowled■e the information contained herein and in the attached schedules is true and complete. I certify <br /> under penalty of perjury under the laws of the State of California that the foregoing is true an• ,rre '. / / <br /> Executed on //2B/gyp a BY y '� ., / / <br /> lure of i� 't ae���� <br /> 2.--6./Z2.-070 B L%� <br /> Executed on Y <br /> Signature o • gOfficeholder,.4 didai Stat��-asur=Proponent or Responsible Officer of Sponsor <br /> Executed on By <br /> Date Signature of Controlling Officeholder,Candidate,State Measure Proponent <br /> Executed on By <br /> Date Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 460(January/05) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) <br /> State of California <br />