Laserfiche WebLink
Recipient Committee <br />Campaign Statement <br />Cover Page <br /> <br />(Government Code Sections 84200-84216.5) <br /> <br />SEE INSTRUCTIONS ON REVERSE <br /> <br />Type or print in ink. <br /> <br /> Statement covers period <br /> <br />through ~ <br /> <br />Date of election if applicable: <br /> (Month, Day, Year)0~ <br /> <br />Date Stamp <br /> <br />31 ?H <br /> <br /> CITY CLERK <br /> <br />COVEF~ PAGE <br /> <br />For Official Use Only <br /> <br />1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. <br /> <br />[] Officeholder, Candidate Controlled Committee O State Candidate Election Committee <br /> O Recall <br /> <br />General Purpose Committee <br />~ Sponsored <br />C) Small Contributor Committee <br />(~) Political Parly/Central Committee <br /> <br />[] Ballot Measure Committee 0 Primarily Formed <br /> 0 Controlled <br /> O Sponsored <br /> <br />[] Primarily Formed Candidate/ <br /> Officeholder Committee <br /> <br />2. Type of Statement: <br /> [] Prealection Statement <br /> ~ Semi-annual Statement <br /> [] Termination Statement <br /> [] Amendment (Explain below) <br /> <br />[] Quarterly Statement <br />[] Special Odd-Year Report <br />[] Supplemental Preelection <br /> Statement - Attach Form 495 <br /> <br />3. Committee Information <br /> <br />STREET <br /> <br /> <br /> <br /> <br /> <br />Treasurer(s) <br /> <br />NAME OF ASSISTANT TREASURER, IF ANY <br /> <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREA CODE/PHONE <br /> <br />CITY STATE ZIP CODE AREA CODE/PHONE <br /> <br /> <br /> <br />4. Verification <br /> I hays used all reasonable diliGencs iR preparinG and ravi~wi~ ~is atatement and to the kest of ~y knowled~a fha i~form~tion conlalnad harein and in lhe a~achod schedules is true and complate. I <br /> ceai~ under penal~ of perju~ under the laws of the State of California that the foregoings tree and ~rrect. <br /> <br /> Execut~ on By <br /> <br />Executed on By <br /> <br />By FPPC Form 460 (Julia/01) <br /> <br /> <br />