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Recipient Committee <br />Campaign Statement <br /> <br />(Government Code Sections 84200-84216.5) <br /> <br />Type or print in Ink. <br /> <br />SEE INSTRUCTIONS ON REVERSE <br /> <br />Statement covers period <br /> <br />1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 7. <br /> <br />[] Officeholder, Candidate <br /> Controlled Committee <br /> (Also C~mplete Part 4.) <br /> <br />[] Ballot Measure Committee <br /> O Primarily Formed <br /> O Controlled <br /> C) Sponsored <br /> (Also Complete Part 5 ) <br /> <br />[] Primarily Formed Candidate/ <br /> Officeholder Committee <br /> (Also Complete Part 6.) <br /> <br />~3 General Purpose Committee <br /> ~) Sponsored <br /> O Broad Based <br /> <br />Date of election If applica~A }' <br />(Month, Day. Year) <br /> <br /> Date Stamp <br /> <br />:-RSFIELi~ CITY CLEI~ <br /> <br />2. Type of Statement: <br /> <br /> [] Pre-elec(ion Statement <br /> [] Semi-annual Statement <br /> [] Termination Statement <br /> [] Amendment (Explain below) <br /> <br />COVERPAGE <br /> <br />For Official Use Of~ly <br /> <br />[] Quarterly Statement <br />[] Special Odd-Year Report <br />[] Supplemental Pre-election <br /> Statement - Attach Form 495 <br /> <br />3. Committee Information I "D'~/~// <br /> COMMITTEE NAME <br /> <br /> STREET ADDRESS ( <br /> <br /> <br /> <br /> <br /> <br /> <br />Treasurer(s) <br /> <br />NAME OF TREASURER <br /> <br />MArLiNG NDORESS <br />CIT~ STATE ZtPCODE ~REA COOE/PHONE <br /> <br />CITY STATE ZIP CODE AREA CODE/PHONE <br /> <br />OPTtONAL: FAX I E-MAIL ADDRESS <br /> <br />OPTIONAL: FAX I E-MAIL ADDRESS <br /> <br /> FPPC Fo~m 460 (8199) <br />For Technical Alslstance: 916/322-5660 <br /> Stale of Ca6fornla <br /> <br /> <br />