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Recipient Committee <br />ampaign Statement <br />over Page <br />SEE INSTRUCTIONS ON REVERSE <br />R E C E IV `D <br />Statement covers period <br />from 9/24/2017 <br />through 10/21/2017 <br />Date of election if applicable:, <br />IMonth. Day. Y`ar)1 <br />11107 <br />tify CF <br />I 2b <br />T r.�a <br />A t11;B1� <br />r anie•1sr.. <br />COVER PAGE <br />CALIFORNIA 460 <br />FORM VV <br />Page <br />.J' 'r <br />•r <br />.! <br />1 <br />of <br />5 <br />For Official Use Only <br />1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. <br />• Officeholder, Candidate Controlled Committee <br />O State Candidate Election Committee <br />Q Recall <br />.Aho Complete Psis) <br />❑ General Purpose Committee <br />O Sponsored <br />O Small Contributor Committee <br />O Political Party/Central Committee <br />❑ Primarily Formed Ballot Measure <br />Committee <br />O Controlled <br />O Sponsored <br />(Ale Complete Part 6) <br />❑ Primarily Formed Candidate/ <br />Officeholder Committee <br />(Also Complete Port 71 <br />2. Type of Statement: <br />la Preelection Statement <br />O Semi-annual Statement <br />O Termination Statement <br />(Also file a Form 410 Termination) <br />O Amendment (Explain below) <br />❑ Quarterly Statement <br />❑ Special Odd -Year Report <br />3. Committee Information <br />I D. NUMBER <br />1398708 <br />COMMITTEE NAME (OR CANDIDATE S NAME IF NO COMMITTEE) <br />Klingfus City Council 2017 <br />STREET ADDRESS (NO P O BOX <br />2170 Papaya Dr <br />CITY STATE ZIP CODE <br />La Habra Heights CA 90631 <br />AREA CODE/PHONE <br />760 220-7141 <br />MAILING ADDRESS, IF DIFFERENT) NO AND STREET OR PO BOX <br />-e <br />STATE ZIP CODE <br />AREA CODE/PHONE <br />NAL FAX • E-MAIL ADDRESS <br />Treasurer(s) <br />NAME OF TREASURER <br />Kathleen Farmer <br />MAILING ADDRESS <br />P.O. Box 3193 <br />CITY <br />La Habra Heights <br />STATE 2IP CODE <br />CA 90631 <br />AREA CODE/PHONE <br />562 697-4340 <br />NAME OF ASSISTANT TREASURER. IF ANY <br />MAILING ADDRESS <br />CITY <br />STATE ZIP CODE <br />AREA CODE/PHONF <br />OPTIONAL TAX I E-MAIL ADDRESS <br />4. Verification <br />I have used all reasonable diligence in prepanng 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 <br />certify under penalty of perjury under the laws of the State of California that the foregoing is and correct ,• <br />Executed on 10/D62017 By l • /iq��✓• �•(� <br />li' eture al Tre or Asusrant Treasurer <br />Exe used n <br />Executed on <br />Executed on <br />10/26/2017 <br />Date <br />Date <br />Date <br />By � -•• <br />Signature of Controllingp <br />By <br />By <br />anu-oate State Measure Proponent., Responsible Officer of Sponsor <br />signs <br />lure of Contains OP;cehoidn Candidate Sate Meas+.,. Proponent <br />&(matyre of Controllers Offcehalder Candidate. Slate Measure Proponent <br />FPPC Form 460 (Jan/2016) <br />FPPC Advice: (866/275 3772) <br /> <br />