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Recipient Committee <br />Campaign Statement <br />Cover Page <br />(Government Code Sections 84200- 84216.5) <br />SEE INSTRUCTIONS ON REVERSE <br />Type or print in ink, <br />fro <br />Statement covers period I Date of election if applicable: <br />m <br />July 1, 2011 (Month, Day, Year) <br />through <br />December 31, 2011 <br />1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3 and 4. <br />® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure <br />Q State Candidate Election Committee Committee <br />Q Recall Q Controlled <br />(Also Complete Part 5) O Sponsored <br />❑ General Purpose Committee (Also Complete Part 6) <br />Q Sponsored ❑ Primarily Formed Candidate/ <br />Q Small Contributor Committee Officeholder Committee <br />Q Political Party/Central Committee (Also Complete Part 7) <br />COVER PAGE <br />Date Stamp I <br />_ • <br />RECEIVED O <br />1 4 <br />JAN 3 0 2012 <br />Pa g e For Official Use Only <br />OFFICE OF THE <br />CITY CLERK <br />2. Type of Statement: <br />❑ Preelection Statement <br />Semi - annual Statement <br />❑ Termination Statement <br />(Also file a Form 410 Termination) <br />❑ Amendment (Explain below) <br />❑ Quarterly Statement <br />❑ Special Odd -Year Report <br />❑ Supplemental Preelection <br />Statement - Attach Form 495 <br />3. Committee Information I.D. NUMBER Treasurer(s) <br />1265948 <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER <br />Committee To Elect Don Schweitzer <br />Janis Sch <br />MAILING ADDRESS <br />STREET ADDRESS (NO P.O. BOX) <br />CITY STATE <br />ZIP CODE AREA CODE /PHONE <br />Brea CA <br />CITY STATE ZIP CODE AREA CODE /PHONE <br />NAME OF ASSISTANT TREASURER, IF ANY <br />Brea CA <br />NONE <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET P.O. BOX <br />MAILING ADDRESS <br />CITY STATE <br />CITY STATE ZIP CODE AREA CODE /PHONE <br />ZIP CODE AREA CODE /PHONE <br />Brea CA <br />OPTIONAL: FAX / E -MAIL ADDRESS <br />OPTIONAL: FAX / E -MAIL ADDRESS <br />4. Verification <br />I have used all reasonable diligence in preparing and reviewing this statement and to the <br />s is true and complete. I certify <br />under penalty of perjury under the laws of the State of California that the foregoing is true <br />Executed on January 29, 2012 <br />Date <br />Executed on January 29, 2012 <br />Date <br />Executed on <br />Date <br />B} <br />B� <br />B) <br />Executed on By <br />Date Signature of ControllingOtficeholder, Candidate,StateMeasureProponent FPPC Form 460 (January/05) <br />FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) <br />State of California <br />