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...�.r..� <br /> . <br /> Recipient Committee Date stamp . COVER PAGE <br /> Campaign Statement �' ' � • 1 <br /> Cover Page �����r�.� <br /> Statement covers period Date of election if pplicable: Page � of 5 <br /> from <br /> 1/1/16 (Monch,Day, ear) UL 19 Z016 For Official Use Ordy <br /> SEE INSTRUCTIONS ON REVERSE through 6/30/16 e,y�;;?��i;�u�����ity <br /> 1. Type of Recipient Committee: All Commfttees—Complete PaRs 1,2,s,and 4. 2. Type of St ,�.;,;;��:,,�,,,�, <br /> [✓J Officeholder,Candidate Controlied Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement <br /> � State Candidate Election Committee Committee � Semi-annual Statement ❑ Special Odd-Year F2eport <br /> Q Recail � Controiled ❑ Termination Statement <br /> (AlsoCompfed�Pat 5J � Sponsored (Also file a Form 410 Termination) <br /> {Nso Complete Pari 6) <br /> ❑ General Purpose Committee ❑ Amendment(Expiain below) <br /> � Sponsored ❑ Pnmarily Form�d Candidate! <br /> � Smal!Contributor Committee Officeholder Committee <br /> � Political Party/Centrai Committee ��°0°'P��pe"�� <br /> 3. Committee information �•D.NUMBER Treasurer(s) <br /> 1313963 <br /> COMMfTTEE NAME(OR CAN�IDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br /> JOHN SEYBERT FOR CITY COUNCIL 2013 RICHARD S. CLAIRE <br /> MAILING ADDRESS <br /> <br /> STREETADDRESS(NOP.0.80X) CITY STATE ZIPCODE <br /> <br /> CITY STATE ZIPCODE AREACO�E/PHONE NAMEOFASSISTANTTREASURER,IFANY <br /> REDWOOD CITY CA 94062 <br /> MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O.BOX MAILINC,AD�RESS <br /> CITY STATE 21PCODE AREACODElPHONE CITY STATE ZIPCODE AREACODE/PHONE <br /> OPTIONAL: FAX/E-MAILADDRESS 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 knowledge the information contained herein and in the attached schedules is true and complete, i <br /> certify under penaky ot perjury under the laws of the State of California that the foregoing is tr d rre <br /> Executed on 7/15/16 By l � <br /> Date Sig ture of Treasu r Assist nt Tre <br /> i <br /> Executed on � � �� � � By <br /> Date Sign o er,Cand ate, tete M sure roponant or ResponsiMe OHicar of Sponsor <br /> Executed on By � <br /> ata S�gnaWre d ontrolling Officehoider,Candidate,State Measure roponent <br /> ExecUted ott Date BY Signature of Contrdling Offlceholdar,Candidate,State Measure Proponent <br /> FPPC Form 460(1an/2016j <br /> FPPC Advice:advice�fppc.ca.gov(866/275-3772) <br /> www.fppc.ca.gov <br />