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acipient Committee ampaign Statement
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wernment Code Sections 84200-84216 5)
a INSTRUCTIONS ON REVERSE
Type of Recipient Committee: All Committees •
from
01/01/2012
Date of election if applicable: (Month, Day, Year)
through
03/17/2012
06/05/2012
Statement covers period
Complete Parts 1, 2, 3, and 4.
Primarily Formed Ballot Measure 0 Committee
Officeholder, Candidate Controlled Committee
O State Candidate Election Committee
Controlled 0 Sponsored
O Recall
(Also Complete Pert 5)
(Nso Complete Part 6)
O General Purpose Committee O Sponsored 0 Small Contributor Committee O Political Party/Central Committee
MAR
2 1 2012
JULIE L RODEWALD COUNTY CLEP
2. Type of Statement:
-90444.4Z L,CYL/ p T
ID Quarterly Statement
2 Preelection Statement Semi-annual Statement 0 Termination Statement (Also file a Form 410 Termination) Amendment (Explain below)
D
D Special Odd-Year Report
0 Supplemental Preelection Statement -Attach Form 495
0
Primarily Formed Candidate/ O ffi ceholder Committee
For Official Use Only
(Also Complete Part 7)
I.D. NUMBER
Committee Information
Treasurer(s)
1294032
COMMITTEE NAME (OR CANDIDATES NAME IF NO COMM!
NAME OF TREASURER
EE)
Sharon A. McMahan
Friends of Adam Hill, County Supervisor 2012
MAILING ADDRESS
765 Mesa View Drive #21 STREET ADDRESS (NO P.O. BOX)
STATE
CITY
Arroyo Grande
260 Sandercock CITY
STATE
ZIP CODE
San Luis Obispo
CA
93401
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR
AREA CODE/PHONE
ZIP
C ODE
CA 93420
AREA CODE/PHONE
(805) 481-0268
NAME OF ASSISTANT TREASURER, IF ANY
(805) 550-7916
RO. BOX
MAILING ADDRESS
P.O. Box 1248
, CITY
STATE
CA
Grover Beach
ZIP CODE
AREA CODE/PHONE
STATE
CITY
ZIP CODE
AREA CODE/PHONE
93483
OPTIONAL: FAX / E-MAIL ADDRESS
OPTIONAL: FAX
/ E-MAIL ADDRESS
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 under the laws of the State of California that the foregoing is true and correct. \ \ V4-,A \n"-- NCYv N Executed on
a (,)
Executed on Executed on Executed on
By
By
Date Date
By By
Signatur7f Tr
Signature o
urer or ssistant Treasurer
holder, Candidate, State Measure Proponent or Responsible Officer of Sponsor
Sgnature of Controlling Officeholder, Candidate, State Measure Proponent Signatureof Controlling Officeholder, Candidate, State Mena Proponent
FPPC Form 460 (January/05) FPPC Toll-Free HelplIne: 866/ASK-FPPC (866 1275-3772)
State of California