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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