COVER PAGE
Recipient Committee Campaign Statement Cover Page
Type or print In Ink.
FILEPD
(Government Code Sections 84200-84216.5) Statement covers period
SEE INSTRUCTIONS ON REVERSE
1. Type of Recipient Committee:
from
1/1/2012
through
3/17/2012
Date of election If applicable: (Month, Day, Year)
6/5/2012
For Official USe Only
eeens:ac-D CLERK
2. Type of Statement:
All Committees — Complete Parts 1, 2, 3, and 4.
VI Preelection Statement 0 Semi-annual Statement Termination Statement (Also file a Form 410 Termination) Amendment (Explain below)
0 Controlled 0 Sponsored (Also Complete Par16)
0 General Purpose Committee 0 Sponsored
of _gli -I
JUL E L RODBNALD COUNTY CLEW
Candidate Controlled Committee 2 Officeholder, Formed Ballot Measure 0 Primarily State Candidate Election Committee Committee 0 0 Recall (Also Coma/e/aParrS)
MAR 2 2 2012
Quarterly Statement Special Odd-Year Report Supplemental Preelection Statement - Attach Form 495
Primarily Formed Candidate/ Officeholder Committee
00 Small Contributor Committee Political Party/Central Committee
(Also Complete Part 7)
I.D. NUMBER
3. Committee Information COMMITTEE NAME (OR CANDIDATE S NAME IF NO COMM!
EE)
Treasurer(s)
1256185
NAME OF TREASURER
James E. Dewing
Patterson for Supervisor 20(7--
MAILING ADDRESS
3250 Silla Rd. STREET ADDRESS (NO P.O. BOX)
STATE
CITY
9312 N. Santa Margarita Rd.
Atascadero
CITY
STATE
ZIP CODE
Atascadero
CA
93422
ZIP
CODE
CA 93422
AREA CODE/PHONE
805-461-5658
NAME OF ASSISTANT TREASURER, IF ANY
AREA CODE/PHONE
805-466-2645
Betina Salter
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR RO. BOX
MAILING ADDRESS
PO Box 2515
14080 San Antonio Rd.
CITY
STATE
ZIP CODE
Atascadero
CA
93423
AREA CODE/PHONE
CITY
805-466-2645
STATE
Atascadero
OPTIONAL: FM / E-MAIL ADDRESS
CA
ZIP CODE
93422
AREA CODE/PHONE
805-466-0201
OPTIONAL: FAX / E-MAIL ADDRESS
4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the inforM. ed 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. IS e 4t qr eA... t>iefa. Executed on Data
Executed on Executed on Executed on
Date Data
arva
By
By By
By
tar
PS-14.14:11111411
Signature otControCing Officeholder. Candidate, State Measure Propo
orRespensi
r of Sponsor
Signatureof Controlling Ofticeacdcler, Candfdate, State Measure Pmponent Sfonatufe Of GO ntroling Officeholder, Candidate. State Measure Proponent
FPPC Form 450 (January/0 5 ) FPPC Toll-Free Halpline:1186/ASK-FPPC (866/275-3772) State of California