460 Adolph 2014 from 01/01 - 10/03RetipientCommittee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Officeholder, Candidate Controlled Committee
CITY
Statement covers period
1 A�'�
from _r_
Date of election if applicable:
(Month, Day, Year) I]I1t.
through
O Controlled
(Also Complete Partsl
1. Type of Recipient Committee: An Committees - Complete Parts 1, 2, 3, and 4.
Officeholder, Candidate Controlled Committee
❑ Ballot Measure Committee
Q State Candidate Election Committee
O Primarily Formed
Q Recall
O Controlled
(Also Complete Partsl
O Sponsored
F-1General Purpose Committee
(Also Cotnplee, Part s)
Q Sponsored
❑ Primarily Formed Candidate/
Q Small Contributor Committee
Officeholder Committee
Q Political Party/Central Committee
Pls. Complete Part 7/
3. Committee Information
I'DiiD: B,E,RA .
GUMMI I IEEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
wM I•�rr& —m i -was rr
111"W" i{L�'b{i, C1" oF i b
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
- /
COVERPAGE
-EIM
:RtK'S OFFICE t t t
-3 N 2: 36 Page of�
For Oficial Use Only
OF
2. Type of Statement:
❑ Preelection Statement
Semi-annual Statement
❑ Termination Statement
❑ Amendment (Explain below)
Treasurer(s)
W
❑ Quarterly Statement
❑ Special Odd -Year Report
❑ Supplemental Preelection
Statement - Attach Form 495
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 knowledge the information contained herein and in the attached schedules is true and complete. I
certify under penalty of perjury roar the laws of the State of California that the foregoing
00 is true a--nd'' (correct.
Executed on 0 By
�w Date Si Nre olTreasur rAssislantTreasurer
Executed on r3 M, By
_\
one, Sionaturanfenntrnllinnr ficahM ar condidoix Rtiif, lineae,,.earn..... rt-e ....:uenm...e...re..........
Executed on
By
Signature of Controlling Officehdder. candidate, StateMi Proponent
Executed on By
Date SlgnfltureofCnnVollmg Officeholder, Candidate, Slate Measure Proponent. FPPCFortn 460(JUne/01)
FPPC Toll -Free Helpline: 666/ASK-FPPC
State of California