HomeMy Public PortalAboutForm 470
Officeholder and Candidate
Campaign Statement -
Short Form
(Government Code Section 84206)
Type or print in ink.
Dale Stamp
CALIFORNIA 470'
FORM
SHORT FORM
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RECEIVED
FEB 2 0 2003
For Official Use Only
Date of election if applicable; 0 Amendment (Explain Below)
(Month, Day, Year)
CITY CLERk
CITY OF CLAREMONT
1
1. Statement Covers Calendar Year 20 ~ .
2. Officeholder or Candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
"'J t r F (l {; 'f f'. (11<<;f/1A AJ
STREET ADDRESS
14- u.. ( L3d 11 J/l 4L- i3rr..) iJ Iwe ~ (.4 ? (7 (/
CITY STATE ZIP CODE
C lAic. t/.Il!)IJT
AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX / E-MAIL ADDRESS
3. Office Sought or Held
OFFICE SOUGHT OR HELD
COe.. -1 (Jl Wl/J1N'! be f(
JURISDICTION (LOCATION)
(; - 00{ c Iu-( tA.1.J /v 7
DISTRICT NUMBER
(IF APPLICABLE)
(9dl) L~"o-2 - 71.)J
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 LD. NUMBER COMMITTEE ADDRESS NAME OF TREASURER
x
x
x
x
x
x
5. Verification
I declare under penalty of perjury that to the best of my knowledge I anticipate that I will receive less than $1,000 and that I will spend less than $1,000 during
the calendar year and that I have used all reasonable diligence in preparing this statement. I certify under penalty of perjury under the laws of the State of
California that the foregoing is true and correct.
, 'J
CJ/LJ/'o /
I
DATE
By
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Executed on
FPPC Form 450 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
Officeholder and Candidate
Campaign Statement
Form 470 Supplement
(Government Code Section 84206)
Type or print in ink.
FORM 470 SUPPLEMENT
o Amendment (Explain Below)
Date Stamp
CALIFORNIA 470
FORM SUPPLEMENT
For Official Use Only
"
SEE INSTRUCTIONS ON ~,~RSE
This form is written notifica.tiQn that the officeholder/candidate listed below has received contributions totaling
$1 000 or more or has made expenditures of $1,000 or more during the calendar year.
' ,
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1. Officeholder or Candidate Inf~tion
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NAME OF OFFICEHOLDER OR CANDIDATE
e
STREET ADDRESS
CITY
AREA CODE/DAYTIME PHONE NUMBER
2. Office Sought
OFFICE SOUGHT
DATE OF ELECTION (MONTH, DAY, YEAR)
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3. Date Contributions Totaling $1,000 or More Were Received or Date Expenditures of $1,000 or More Wer~ Made
(MONTH. DAY, YEAR)
FPPC Form 450 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC