Type or print in ink.
COVER PAGE - PART 2
Recipient Committee
CALIFORNIA
460
Campaign Statement
FORM
Cover Page — Part 2
Page
of
6. Primarily Formed Ballot Measure Committee
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
NAME OF BALLOT MEASURE
JURISDICTION
BALLOT NO. OR LETTER
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
SUPPORT
OPPOSE
RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET)
CITY
STATE
ZIP
Identify the controlling officeholder, candidate, or state measure proponent, if any.
NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT
Related Committees Not Included in this Statement:
List any committees
OFFICE SOUGHT OR HELD
DISTRICT NO. IF ANY
not included in this statement that are controlled by you or are primarily formed to receive
contributions or make expenditures on behalf of your candidacy.
COMMITTEE NAME
I.D. NUMBER
7. Primarily Formed Candidate/Officeholder Committee
List names of
CONTROLLED COMMITTEE?
NAME OF TREASURER
officeholder(s) or candidate(s) for which this committee is primarily formed.
YES
NO
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
COMMITTEE ADDRESS
STREET ADDRESS (NO P.O. BOX)
SUPPORT
OPPOSE
CITY
STATE
ZIP CODE
AREA CODE/PHONE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
SUPPORT
OPPOSE
COMMITTEE NAME
I.D. NUMBER
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
SUPPORT
OPPOSE
CONTROLLED COMMITTEE?
NAME OF TREASURER
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
SUPPORT
YES
NO
OPPOSE
COMMITTEE ADDRESS
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
Attach continuation sheets if necessary
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Print Form
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
State of California