R I I,Recipient Committee Campaign statement COVER PAGE (Government CODe Sections 84200-84216.5) Type or print In Ink. Statement covers period from I / t!' fa-olo SlOE INSTRUCnONS ON REVERSE 1_. Type of Statement: o Termination Statement (Also file a FORM 410 Termination) For Official Use OnlY' lii Quarterly statement o Special
R I I,Recipient Committee Campaign statement COVER PAGE (Government CODe Sections 84200-84216.5) Type or print In Ink. Statement covers period from I / t!' fa-olo SlOE INSTRUCnONS ON REVERSE 1_. Type of Statement: o Termination Statement (Also file a FORM 410 Termination) For Official Use OnlY' lii Quarterly statement o Special
R I I,Recipient Committee Campaign statement COVER PAGE (Government CODe Sections 84200-84216.5) Type or print In Ink. Statement covers period from I / t!' fa-olo SlOE INSTRUCnONS ON REVERSE 1_. Type of Statement: o Termination Statement (Also file a FORM 410 Termination) For Official Use OnlY' lii Quarterly statement o Special