HomeMy Public PortalAboutForm 470Oi~~eholder and Candidate Type or print inlnk.
Campaign Statement -Short Form
(Government Code Section 84206)
For use by officeholders and candidates who do not have a controlled committee and who do not anticipate
receiving 51,000 or more in contributions and do not anticipate spending X1,000 or more during the
calendar year. Officeholders whose salary is less than X100 per month and judges who have a controlled
committee may use this form under certain circumstances. See the Information Manual on Cam ai n
Disclosure Provl ions of the Political Reform Act for Elected Officeho ers, Can I ales, an T eir Controlled
or
Ion.
I Statement Covers Calendar Year 19 1~ .
Date Stamp
~EcE~ VE®
SAN 2 1 1999
CITY OF C~REIIKi1pwT.
SHORT FORM
For 0lficial Use Only
II Officeholder or Candidate Information III Information on Office Sought or Held
VAME OF,LO~FF~IC,E~HOLDER OR CANDIDATE OFFICE /S~O,,UGHT OR HELD !/' I / / 1
~ j ~ w~ n ~ U (~ lC ~.C ~/ ~liL~,t, ~ C (~ (~ •i' ~ I G 2 i.~ U ,~ t C l r l l V l t n c/ 1
RESIDENTIAL OR BUSINESS ADDRESS (NO.-AND STREET) JURISDICTION (LOCATION) DISTRICT NUMBER
Lr / f ~ 1 • I ~ ~. (~ ~ .~ ~ (IF APPLICABLE)
CITY STATE ZIP CODE DATE OF ELECTION (MONTH, DAY, YEAR) (IF APPLICABLE)
AREA CODE/DAYTIME PHONE NUMBER
IV 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.
' ~I~ S ~ . 12~`~ S ~ .
V Verification
I declare under penalty of perjury that to the best of my knowledge, I anticipate that I will receive less than f 1,000 and that I will spend less than S 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.
Executed on
DATE
At ~ ~C;(YvvlOn .1, ~C. gy
arr AND STATE
~I
SIGNATURE OF OFF~pEDFR OR CANDIDATE
FOR INFORMATION RFOUIRED TO BE PROVIDED i0 YOU PURSUANT 10 THE INFORMATION PRACTICES AC7 OF 1971, SFF INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OE iH[ POInICAI RffORM ACT.
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