HomeMy Public PortalAboutForm 470
Officeholder and Candidate
Campaign Statement -
Short Form
(Government Code Section 84206)
Date of election If applicable:
(Month, Day, Year)
0 Amendment (explain Below)
Date Stamp
RECEIVED
JAN 2 6 2005
CALIFORNIA 470
FORM
SHORT FORM
Type or print In Ink.
For 0IftcIaJ. Use Only
rJ!?f(Ó)
CITY CLERK
CITY OF CLAREMONT
1. Statement Covers Calendar Year 20 t5 tf :- ô S--
2. Officeholder or Candidate "Information
NAME OF OFFICEHOLDER OR CANDi"TE) r
~ t é (" 'd ~ ~. -0 ~ V)
STREET ADDRESS
~3<;
CITY
3. O,ffice Sought or Held
t OFFICE SOUGHT OR HELD ~ "
lC ~€t/1 'd- L-¡ C( C7vev-....~+ c..L ~ Co U VI C-L J
n {] JURISDICTION (LOCATION) , , ' J DISTRICT NUMBER
W.P ç--t- (cH Vi -;) 7 71 ?-r ( c ~ +- 6 fer g v E? V1I'l t)") T (IF APPUCABLE)
STATE ZIP CODE J
/::-1 D -- t::£ -e Vt?-t-? ~ ~ ~. c~
OPTIONAl: FAX/E-MAILADDRESS jc:;'
AREA CODBDAYnME PHONE NUMBER
4. Committee Information
Ust all committees of which you ha ve knowledge that are primarily formed to receive contributions or to make expenditures on behalf of your candidacy.
COMMITTEE NAME AND lD. NUMBER COMMITTEE ADDRESS NAME OF TREASURER
YL/?-'
h I?-
5. Verification
I
I declar, e, 'under pen, a Ity, of pe~ury th,at to t, he best of my knowledge I anticipate that I will "ve les, S than $1~OOO ..tt}át I will spp~d less than $1,000 during
the calendar year and that I have used all reasonable diligence in preparing this stat ent. certify under pe Ity of (IIorjllty uÌlder \he laws of the State of
CaUfomia that the fo~egoing is true an,d correct. WA.t"" ~ ,C"\ J .
'J <) /Ï {()- "} ./rJ'I ~ "j /. ~ ]/~ - - '
Executed on r ~ ~ v I ¿/t./ (/ ...) By'v., {, ~ - ~
DATE / .,' / 7' s.G OF OFACEHOlDER OR CANDIDATE
() FPPC Form 450 (Junem1
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