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Recipient Committee <br />Campaign Statement <br />Cover Page <br /> <br />(Government Code Sections 84200-84216.5) <br /> <br />SEEINSTRUCTIONS ON REVERSE <br /> <br />Type or print in ink, <br /> <br /> Statement covers period <br />,rom r/_ I-o <br /> <br />through <br /> <br />Date of election if a <br /> (Month, Day, Year) <br /> <br />Date Stamp <br /> <br /> 03FEB-3 PM I: <br />BAKERSFIELD Cli 'f <br /> <br />covEF~ PAGE <br /> <br /> For Official Use Only <br />ERK <br /> <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 Como/ere Part 5) <br /> <br />General Purpose Committee <br />(~ Sponsored <br />O Small Contributor Committee <br />O Political Party/Central Committee <br /> <br />[] Ballot Measure Committee O Primarily Formed <br /> O Controlled <br /> O Sponsored <br /> [ALSO Complete Part E) <br /> <br />[] PrimadlyFormedCandidate/ <br /> Officeholder Committee <br /> (Also Cemp~te Part 7) <br /> <br />2. Type of Statement: [] Preelection Statement <br /> [~ Semi-annual Statement <br /> [] Termination Statement <br /> <br /> [] Amendment (Explain below) <br /> <br />[] Quaderly 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 /> <br /> <br />Treasurer(s} <br /> <br />N E OF TREASURER <br /> <br />NAME OF ASSISTANT TREASURER, IF ANY <br /> <br />MAILING ADDRESS (IFDIFFERENT) NO. AND STREET OR PO BOX MAILING ADDRESS <br /> <br />C~TY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE <br /> <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 statement and to the best of my knowledge the information contained 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 toregoing is true and correct <br /> <br /> U' D~ ] - Signature of Treasurer or Assistant Trea surer <br /> <br /> Executed on <br /> Date SJ~atu[~ of Controlkng Officeholder, Candidale Stale Measure Proponenl or Responsibie OflicRr ol Sponsor <br /> <br />Executed on By <br /> <br />Signalure of Controlling Officeholder, Candidate Slale Measure Proponenl <br /> <br />Executed on By <br /> <br />Dale <br /> <br /> FPPC Form 460 {June~01} <br />FPPC Toll-Free Helpllne: 866/ASK-FPPC <br /> State of California <br /> <br /> <br />