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Recipient Committee <br />Campaign Statement <br />Cover Page — Part 2 <br />5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee <br />NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE <br />Carey Klingfus <br />OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) <br />City Council 2017 <br />RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP <br />2170 Papaya Dr La Habra Heights CA 90631 <br />Related Committees Not Included in this Statement: List any committees <br />not included in this statement that are controlled by you or are primarily formed to receive <br />contributions or make expenditures on behalf of your candidacy. <br />COMMITTEE NAME <br />I.D. NUMBER <br />NAME OF TREASURER <br />CONTROLLED COMMITTEE? <br />❑ YES ❑ NO <br />COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) <br />CITY <br />STATE ZIP CODE AREA CODE/PHONE <br />COMMITTEE NAME <br />I.D. NUMBER <br />NAME OF TREASURER <br />CONTROLLED COMMITTEE? <br />0 YES 0 NO <br />COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) <br />CITY <br />STATE ZIP CODE AREA CODE/PHONE <br />COVER PAGE - PART 2 <br />CALIFORNIA 460 <br />FORM <br />IPage 2 of <br />5 <br />BALLOT N• OR LETTER <br />JURISDICTION <br />❑ SUPPORT <br />❑ OPPOSE <br />Identify the controlling officeholder, candidate, or state measure proponent, if any. <br />NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT <br />OFFICE SOUGHT OR HELD <br />DISTRICT NO. IF ANY <br />7. Primarily Formed Candidate/Officeholder Committee List names of <br />officeholder(s) or candidate(s) for which this committee Is primarily formed. <br />NAME OF OFFICEHOLDER OR CANDIDATE <br />OFFICE SOUGHT OR HELD <br />❑ SUPPORT <br />❑ OPPOSE <br />NAME OF OFFICEHOLDER OR CANDIDATE <br />OFFICE SOUGHT OR HELD <br />0 SUPPORT <br />❑ OPPOSE <br />NAME OF OFFICEHOLDER OR CANDIDATE <br />OFFICE SOUGHT OR HELD <br />❑ SUPPORT <br />❑ OPPOSE <br />NAME OF OFFICEHOLDER OR CANDIDATE <br />OFFICE SOUGHT OR HELD <br />0 SUPPORT <br />0 OPPOSE <br />Attach continuation sheets it necessary <br />FPPC Form 460 (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />