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COVEF~ PAGE <br />Rec.plent Committee oate S~am. <br /> <br />Campaign Statement <br />Cover Page <br /> <br />(Government Code Sections 84200-84216.5) <br /> <br />Type or print in ink. <br /> <br /> I Statement covers period <br /> ,rom 7-1-05k <br />SEE INSTRUCTIONS ON REVERSE through q -- ~) '~ <br />1. Type of Recipient Committee: All Committees- Complete Parts 1, 2, 3, and 4. <br /> <br />[] Officeholder, Candidate Controlled Committee <br /> O State Candidate Election Committee <br /> O Recall <br /> (Also Complete Part 5) <br />A eneral Purpose Committee <br /> oc) SPns°red <br /> Small Contributor Committee <br /> O Political Party/Central Committee <br /> <br />[] Ballot Measure Committee O Primarily Formed <br /> O Controlled <br /> O Sponsored <br /> <br />[] Primarily Formed Candidate/ <br /> Officeholder Committee <br /> <br />Date <br /> <br />of election if applicable: <br />(Month, Day, Year) <br /> <br />Type of Statement: <br />~ Preelection Statement <br />[] Semi-annual Statement <br />[] Termination Statement <br />[] Amendment (Explain below) <br /> <br />Page <br /> <br />of _L.~__ <br /> <br />For Official Use Only <br /> <br />[] Quarterly Statement <br />[] Special Odd-Year Report <br />[] Supplemental Preelection <br /> Statement - Attach Form 495 <br /> <br />3. Committee Information <br /> <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br /> <br />Treasurer(s) <br /> <br />NAME OF TREASURER <br /> <br /> <br /> <br /> <br /> <br /> <br />SZRFFT ^OOR.S~3 (No ",0. ~OX.) <br /> <br /> CODE/PHONE <br /> <br />MIAILING ADDRESS (IF DIFFERENT) NO, AND STREET OR P.O BOX MAILING ADDRESS <br /> <br />~,. 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 /> <br />4. Verification <br /> I have used all reasonable diligence in preparing and reviewing this stalement and to the best of my knowledge the information conlained herein and in the attached schedules is true and complete I <br /> certify under penalty of perjury under the laws of the State of California that the foregoing is lrue a~d correct. <br /> <br />Executed on <br /> <br />Date <br /> <br />By <br /> <br /> FPPC Form 460 (June/01) <br />FPPC Toll-Free Helpline: 8661ASK-FPPC <br /> State of Calllornla <br /> <br /> <br />