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Recipient Committee <br />Campaign Statement <br />Cover Page <br />SEE INSTRUCTIONS ON REVERSE <br />Statement[��co ers period <br />from3kL\ \ -20 Nt% <br />,f� <br />throug S\ 2`'6 <br />1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. <br />0/Officeholder, Candidate Controlled Committee <br />• State Candidate Election Committee <br />O Recall <br />(Also Complete Pat 5) <br />❑ General Purpose Committee <br />O Sponsored <br />O Small Contributor Committee <br />O Political Party/Central Committee <br />❑ Primarily Formed Ballot Measure <br />Committee <br />O Controlled <br />O Sponsored <br />(Also Complete Pat 6) <br />❑ Primarily Formed Candidate/ <br />Officeholder Committee <br />(Also Complete Part 7) <br />Date of election if applicable: <br />(Month, Day, Year) <br />2. Type of Statement: <br />❑ Preelection Statement <br />demi-annual Statement <br />❑ Termination Statement <br />(Also file a Form 410 Termination) <br />❑ Amendment (Explain below) <br />Date Stamp <br />COVER PAGE <br />CALIFORNIA 460 <br />FORM <br />`i ,, r, N I :r 21� a <br />For Official Use Only <br />0 Quarterly Statement <br />❑ Special Odd -Year Report <br />3. Committee Information <br />I.D. NUMBER <br />t 3T1S 5S <br />COMMITTEE NAME (OR CANATE'S NAME IF NO COMMITTEE) <br />� <br />EETADDRESyS (NO P.O. BOX) <br />CITY <br />STATE <br />ZIP CODE <br />AREA CODE/PHONE <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX <br />ZIP CODE AREA CODE/PHONE <br />Treasurer(s) i� <br />NAME OF TREASURER <br />I t \ADDRESS <br />CITY <br />STATE ZIP CODE <br />AREA CODE/PHONE <br />NAME OF ASSISTANT TREASURER, IF ANY <br />MAILING ADDRESS <br />AREA CODE/PHONE <br />4. Verification <br />I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge <br />certify under penalty of perjury under he laws of the State of California that the foregoing is true and <br />Executed on <br />Executed on <br />Executed on <br />Executed on <br />�t 1c) <br />Date <br />Date <br />Date <br />By <br />By <br />By <br />By <br />he information contained herein and in the attached schedules is true and complete. I <br />Signature of Treasurer or Assistant reasurer <br />Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor <br />asure Proponent <br />asure Proponent <br />FPPC Form 460 (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />