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Committee Campaign Statement Cover Page

Government Cotle
SeMlons

Recipient

V C F
Type
or

OVER PAGE
e

print in Ink

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LLTPr
Pit 12 39
Page
1
of

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Statement from
covers

perlotl

Oate of election ii

ZDD8 Dl D7

appllc Month Day VeaQ

ei

nP

For OMUaI USe

Only

SEE INSTRUCTIONS ON REVERSE

through
All

2008 30 09
2

2006 06
Type
of Statement
Statement

Type

of

Recipient

Committee

templets commin

Pan t x a ana 4 Formed Ballot Measure

0 Oficeholtler Cantlitlate Controlled Committee State Canditlate Election Committee Q Recall


Tao camyro PMS

Primarily

Preelection

Committee

Quarterly

Statement

annual Semi Statement Termination Statement Also file a Fortn 410 Termination Amentlment

QControlletl Q Sponsored
peermryme Pertsl

Special OddYear Report


Su pp leman Preelection al

Attach Statement Form 495

General POrpose COmmiHee

Explain below

Q Sponsored Q Small Contributor Committee Q Political Party Committee Central


3

Pdmadly FOrmetl Cantlitlatel Offmeholtler Committee


acwiPerevan fA I

Cover

Paae

Tvpe Df Statement

Committee Information
COMMITTEE NAME

O I

NUMBER

970413
COMMITTEE

s Treasurer
NAME OF TREASURER

OR

S CANOmATE NAME IF NO

Friends of Elliott Rothman

Kinde Durkee
MAILING ADDRESS

1212 S
STREET ADDRESS NO P 60 O CITY

Victory B
STATE ZIP CODE

AREA CODE PHONE

1190
CITY

Sequoia

Glen
STATE
21P CODE

Burbank
AREA CODE PHONE
NAME OF ASSISTANT

CA
TREASURER
IF ANV

61502

0669 260 816

Pomona
1212 S
LITY

CA
BI
STALE

91766

0669 260 816


MAILING ADURE56

MAILING ADDRESS IF DIFFERENn NO AND STREET OR P 60 O

Victory

21P CODE

PHONE AREA LODE

CITT

STATE

ZIP

LODE

AREA LOGE PHONE

Burbank
OPTIONAL
FA E ADDRESS MAIL

CA

91502

0669 260 818


OPTIONAL MAIL FA E ADORE65

Verification
I have usatl all reasonable untler

tliligence in preparing

antl

reviewing this statementantlbthe

penalty

of

perjury
on

untler the laws o State of California thatthe the

foregoing

best of my knowletlge the informati is tme and wrrect

ncontained herein antl in the attached schetlules is true and

complete ICerlify

Exeatatl

2D08 08 10
D

aY

Kinde Durkee eWTippur


rot

AS

Itt

Eaamatl

on

2D08 08 10
oam

Ry

Elliott Rothman
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wsure

aeaponeluMOmrmsponbr rema Piop

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on Cab

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Sble ceMNem M1bssue Pmwnent

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on CNa

BY
Slgrenrreoltonucpbg
IAamNer famlmmsbte Meewrepmponem FPPC Toll Free

Helpllne

FPPC Form 460 65 January FPPC 6 B66IASK IBfi612 AT2

Slate or CelNOrnla

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