HomeMy WebLinkAboutKC EMPLOYEES PAC PREELEC01(1) AMEND ecipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Statement covers period
,rorn~('~7- I --OI
through ~ -- ~ ~)-~) I
Date of election if applicable:
(Month, Day, Year)
Date Stamp
COVEF~PAGE
For Official Use Only
1. Type of Recipient Committee: AII Cornmitteea- Complete Parts t, 2, 3, and4.
[] Officeholder, Candidate Controlled Committee O State Candidate Election Committee
O Recall
'j~ General Purpose Committee O Sponsored
O~ Small Contributor Committee
Political Party/Central Committee
[] Ballot Measure Committee O Primarily Formed
O Controlled
O Sponsored
[] Primarily Formed Candidate/
Officeholder Committee
3. Committee Information
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CiTY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX I E-MA~L ADDRESS
2. Type of Statement:
[] Preelection Statement ~i~Ouartedy Statement
[] Semi-annuaIStatement [] Special Odd-Year Report
[] Termination Statement [] Supplemental Pmelecfion
'[~ Amendment (Explain below) ~ Statement - Attach Form 495
Treasurer(s)
MAILING ADDRESS
CITY STATE ZiP CODE AREA CODE/PHONE
¢ ,ATFASS'STANTTREASDRER,'FA"¥
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX ! E-MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my kr~tledge the I~ormation contained herein and in the attached schedules is tree and complete.
certify under penalty of perjury under:e laws of ~he State of California that the Ioregoin~J~s trm~'J~"d,~c-t. ~/,.~,..~
..c.ed0. o,
Executed on
Executed on By
By FPPC Form 460 (June/01)
Executed on D~e Signalum d Cont~ ~, Canddale, Sta~ Veasu~ I~ FPPC Toll-Free Helpllne: 86E/ASK-FPPC
State of California