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