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02. Form 470
Officeholder and Candidate Campaign Statement — Short Form Date of election if applicable: (Month, Day, Year) it/0V20ZZ 1. Statement Covers Calendar Year 20 2 2 - ❑ Amendment (Explain Belo w) Date Stamp CALIFORNIA 470 FORM T For Official Use Only 2. Officeholder or Candidate Information NAME OF OFFICEHOLDER OR CANDIDATE a wVCcL. r -e STREET ADDRESS ZS Four bes Ave' CITY STATE ZIP CODE 3. Office Sought or Held OFFICE SOUGHT OR HELD Co u n' t I JURISDICTION (L0/10N) CAcore WtQ C AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX / E-MAIL ADDRESS ID) 2 c° b 3 B L- (mrce,C,a r 4-e,r y wt a l i cv 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 COMMITTEE ADDRESS I DISTRICT NUMBER (IF APPLICABLE) 3 NAME OF TREASURER NIA N /Pc N/A NAA 5. Verification 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 ©1/29)loZ2 DATE By 'm tea Can tw.y SIGNATURE OF OFFICEHOLDER OR CANDIDATE FPPC F orm 470/470 Supplement (Jan/2016) FPPC Ad vic e: advice @fppc.ca .gov (866/275-3772) www .fppc .ca.go v