HomeMy Public PortalAboutForm 470
Officeholder and Candidate
Campaign Statement -
Short Form
(Government Gode Section 84206)
Type or print in ink.
Date of election if applicable: 0 Amendment (Explain Balow)
(Month, Day, Year)
JAN 1 9 'lIXf/
For Official Use Only
()~/67I-zo{)+-
(
CITY CLERK
CfJV OF Ct.AAEMONT
1. Statement Covers Calendar Year 20 Q...:1:: .
2. Officeholder or Candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
j\J1iDkd<_C ,-)O{.,v.,
STREET ADo!,ess
We sf (o-f(~
,
le",.v " '?--'
l _'--_ t......... () V'J
3. Office Sought or Held
OFFICE SOUGHT OR HELD
/' -'?f- /7, ., ,7
~ lA-, ~/VVL/2..-<-c
5)7
CITY STATE ZJP.CODE
Cr;",.ve. w.o YI-r ,Cf:T('--f '1 (7-'((
AREA CODE/DAYTIME PHONE NUMBER ( OPTIONAL: FAX I E-MAil ADDRESS
lrO 'f-<,- 'YJAI C. h;;'c/kc'€ VI h1 ,1) G Yv/dtL-' Cd~
g{v-ee, f
JURISDICTIONi OCATJON)
~
~
DISTRICT NUMBER.
(IF APPLICABLE)
4. Committee Information
List all committees of which you have knowledge that are primarily formed to receive contributions or to make expenditures on behalf of your candidacy,
COMMITTEE NAME AND 1.0. NUMBER COMMITTEE ADDRESS NAME OF TREASURER
Yi!'O'
)1 (8
5. Verification
I declare under penalty at perjury that to the best at my knowledge I anticipate that I will receive less than $1,000 and that I will spend less1han $1,000 during the
calendar year and that I have used all reasonable diligence In preparing this sta~~certify under penalty of perjury r the la of th ,State of California
that the foregoing is, true and forrec!. / .~ 0/' '
0/ /~ II 7/10 -., - . Y;'" ~ d
Executed on I / C-/ ---- --r-- / / I
! ! DATE C_ ( SIGNATU
FPPC Form 470/470 Supplement (January/OS)
fPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)