/news-slo%20scene-waage-4:5

Page 1

COVER PAGE

Recipient Committee Campaign Statement Cover Page

(Government Code Sections 84200-84216 5)

Statement covers period

SEE INSTRUCTIONS ON REVERSE

from

01/01/2012

(Month, Day, Year)

MAR 2 0 2012

through

03/17/2012

06/05/2012

Page

.1411EL RODSNA.D CCUNTY aiRK npoi Iry r 2. Type of Statement: Preelection Statement 0 Semi-annual Statement 0 Termination Statement (Also file a Form 410 Termination) 0 Amendment (Explain below)

O

(Also Compete Pad 6)

0 General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee

CALIFORNIA 2001/02 FORM

FILED

Date of election if applicable:

1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. jyj Officeholder, Candidate Controlled Committee 0 Primarily Formed Ballot Measure Committee 0 State Candidate Election Committee Controlled 0 Recall (Also Complete Pert 5) 0 Sponsored

3.

Date Stamp

Type or print in ink.

Formed Candidate/ o Primarily Officeholder Commit/ee

1

460

of

19

For Official Use Only

PlC

Quarterly Statement Special Odd-Year Report Supplemental Preelection Statement - Attach Form 495

(Ms* Complete Pait 7) I.D.

Committee Information

COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)

NUMBER

Treasurer(s)

1:14256A

NAME OF TREASURER

Katherine Hartig

Ed Waage for Supervisor 2012

MAILING ADDRESS

175 Whitecap St

STREET ADDRESS (NO P.O. SOX)

193 Wave Ave

STATE

CITY

Pismo Beach

CA

ZIP CODE

93449

CITY

STATE

Pismo Beach

CA

Pismo Beach

CA

ZIP CODE

MAILING ADDRESS STATE

CITY

AREA CODE/PHONE

ZIP CODE

AREA CODE/PHONE

93449 OPTIONAL: FAX / E-MAIL ADDRESS

OPTIONAL: FAX / E-MAIL ADDRESS

4.

805-773-1549

805-773-1549

791 Price St. 136 STATE

93449

AREA CODE/PHONE

NAME OF ASSISTANT TREASURER, IF ANY

AREA CODE/PHONE

MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY

ZIP CODE

Verification

I have used all reasonable diligence in preparing 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 certify under penalty of perjury under the laws of the State of Califomia that the foregoing is true and correct. Executed on

03/20/2012

Executed on

03/20/2012

Executed on Executed on Direct Ale

t_

Data Date Date Date

By

Katherine Hart'

By

Ed Waage

By By

tvature

of Treasurer or Assistant Tr

Signature of Controlling Otficeholder.Candidate, State Measure PĂ­400entor Responsible CM:ere/Sponsor Signature of Controlling Officeholder.

Candodate,

State Measure Proponent

Signature of ControlIng Ofkehokler.Candtdate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll-Free Heipline: 866/ASK-FPPC 036612764772)

State of California


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