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1* <br />Recipient Committee <br />Campaign Statement <br />Cover Page <br />(Government Code Sections 84200-84216.5) <br />SEE INSTRUCTIONS ON REVERSE <br />Statement covers period <br />from 07/01/2018 <br />through 09/22/2018 <br />i. Type of Recipient Committee; All Committees — Complete Parts 1, 2, 3, and 4. <br />❑x Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure <br />0 State Candidate Election Committee Committee <br />0 Recall 0 Controlled <br />i y (Also Complete Part 5) 0 Sponsored <br />-- 'j <br />w. ❑ General Purpose Committee {Also Complete Part 6) <br />0 Sponsored ❑ Primarily Formed Candidate/ <br />0 Small Contributor Committee Officeholder Committee <br />0 Political Party/Central Committee (Also Complefe Pail 7) <br />3. Committee Information I.D. NUMBER <br />1403120 <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br />PAULETTE MARSHALL CHAFFEE FOR FULLERTON CITY COUNCIL 2018 DISTRICT 5 <br />STREET ADDRESS (NO P.O. BOX) <br /> <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />FULLERTON A <br />Date Stamp <br />Date of election if applicable: <br />COVER PAGE <br />(Month, Day, Year)i� �; Pagel of 16 <br />00 302 EF1 For Official Use Only <br />11/06/2018 1 / <br />J V 11 V <br />2. Type of Statement: <br />❑x Preelection Statement ❑ Quarterly Statement <br />❑ Semi-annual Statement ❑ Special Odd -Year Report <br />❑ Termination Statement <br />(Also file a Form 410 Termination ❑ Supplemental Preelection <br />) Statement -Attach Form 495 <br />❑ Amendment (Explain below) <br />Treasurer(s) <br />NAME OF TREASURER <br />MICHELLE MOORE SANDERS <br /> <br /> = <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />INGLEWOOD CA 90301 ( <br />NAME OF ASSISTANT TREASURER, IF ANY <br />C 92831 (310)817-6679 CINE IVERY 4' <br />MAILING <br /> <br /> STATE ZIP CODE AREA CODE/PHONE <br />INGLEWOOD CA 90301 INGLEWOOD CA 90301 <br />( <br />OPTIONAL: FAX ! E-MAIL <br /> <br />4. Verification <br />I have used all reasonable diligence in preparing and reviewing this statententt- nd to the be €-my" edge the information contai herein and in the attached schedules is true and complete. I certify <br />under penalty of perjury under the laws of the State of California that N'Te oreooi a rrPr __1� N <br />Executed on 09/23/2018 <br />Date <br />Executed on 09/23/2018 <br />Date <br />Executed on <br />Date <br />Executed on <br />Date <br />www.netfile.com <br /> <br /> <br />By <br />Signature otContrdlingOtrrcehdder,Candidate State Measure Proponent <br />By <br />Signature of Controlling Off oeholder Candidate, State Measure Proponent <br />FPPC Form 460 (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />