HomeMy Public PortalAboutForm 470Officeholder and Candidate
Campaign Statement -
Short Form Date of election if applicable:
(Month, Day, Year)
111-6—/g
1. Statement Covers Calendar Year 20 19
11 Amendment (Explain Below) I OCT 0 8 2018
-_, CITY CLFF'K
Official Use Only
2. Officeholder or Candidate Information 3. Office Sought or Held
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD J
coicnCi'l
STREETADDRESS JURISDICTION (LOCATION) I DISTRICT NUMBER
(012 weGlesley Dr.
M J 11 I (IF APPLICABLE}
CITY STATE ZIPCODE
64'z'r0- M4e59 9i7//
AREA CODEIDAYTIME PHONE NUMBER OPTIONAL: FAX/E-MAIL ADDRESS
9Q?— 4,'f
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 I.D. NUMBER
tl00C-1
5. Verification
COMMITTEE ADDRESS
NAME OF TREASURER
I declare under penalty of perjury that to the best of my knowledge I anticipate that I will receive less than $2 :000 and that I will spend less than $2,000 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 �2 64 By "'�
E SIGNATURE OF OFFIGEHil CANDIDATE
FPPC Form 470/470 Supplement (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/2753772)
www.fppc.ca.gov