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Recipient Committee Stamp COVER PAGE <br /> Campaign Statement RECEIVED CAFIORMNIA 460 <br /> Cover Page C RANCHO PALOS v- _ <br /> Page 4_____ of <br /> Statement covers period Date of election if applicable: [JUL 1 13 i 2017 <br /> from J w <br /> { Ci 1• ' i2-0 <br /> �)17 (Month,Day,Year) For Official Use Only <br /> SEE INSTRUCTIONS ON REVERSE through+U n e.' )g 20 ii //-p S-261 ogtTY CLERK'S OFFICE <br /> ICE <br /> 1. Type of Recipient Committee: All Committees-Complete Parts 1,2,3,and 4. 2. Type of Statement: <br /> EX Officeholder,Candidate Controlled Committee 0 Primarily Formed Ballot Measure 0 Preelection Statement 0 Quarterly Statement <br /> O State Candidate Election Committee Committee g.Semi-annual Statement 0 Special Odd-Year Report <br /> O Recall 0 Controlled 0 Termination Statement <br /> (Also Complete Ped 5) 0 Sponsored (Also file a Form 410 Termination) <br /> (Also Complete Ped 6) <br /> 0 General Purpose Committee 0 Amendment(Explain below) <br /> O Sponsored 0 Primarily Formed Candidate/ <br /> O Small Contributor Committee Officeholder Committee <br /> 0 Political Party/Central Committee so Complete Pad 7) <br /> l3,.s�,0 l� <br /> 3. Committee Information I.D.NUMBEGG��GG�f Treasurer(s) <br /> COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER/ <br /> atrbara ...ir-aro Fel' ''4t'he'lLo lostit Git-f- es V Irerra.r0 <br /> MAILING ADDRESS <br /> Cc 7y £ot e; / <br /> STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE <br /> ?an�ll.o Palos Verdes, cp `70 273- ala-3 77-/s92 <br /> CITY��yI� Uf STATE` ZIP CODE AREA CODE/PHONE 9NAM OF ASSISTANT TREASURER,IF ANY <br /> 2. <br /> MAILING c ADDRESS Pa-las <br /> V) AND idsTREET CP.O.BROX 4 to.27. . <br /> 7 B i 0 -3 77 /� MAILING ADDRESS <br /> CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE <br /> OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS <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 foregoing <br /> <br /> <br /> <br /> Officer of Sponsor <br /> Executed on By <br /> Date Signature of Controlling Officeholder,Candidate,State Measure Proponent <br /> Executed on By <br /> Date Signature of Controlling Officeholder,Candidate,State Measure Proponent <br /> FPPC Form 460(Jan/2016) <br /> FPPC Advice:advice@fppc.ca.gov(866/275-3772) <br /> www.fppc.ca.gov <br />