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470 fficeholder and Candidate , SHORT FORM Campaign Statement- Typeor Ixlnt In Inl~ ShortForm ' E CI:~'~n~ E £'/,LIF©F~NI~F©R~ 470 (GovemmentCodeSecttm~206) DMeofelectlofllfapldlcable: [] Amendment (Exp~n~o~ C~ p;=RTINO CITY CLE:~K ¶, Statement Covers Calendar Year 20 O / . 2. Officeholder er Candidate Information 3. Office Sought er Held JURISDICTION (LOCA:I~ON) STREET AODRE88 I DISTRICT NUMBER CRY STALE ZIP CODE AREA ~Y11ME F'HONE #UMBER OPTIONAL: FAX I E,MNL ADDRE88 4. Committee Information List all commiflees of which you have knowledge that am p~fma~fly formed to receive conkfbutions or to make expenditures on beha/t'ofyour candidacy. COMMi] i~:E NNdE AND I.D. NUMBER COMMITTEE ADORESS N/k~IE OF TREASURER 6. Veriflcat~on I declare under penalty of perjury'that to the best of my knowledge I anlicipate that I will receive less than $1,000 end 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 Form 47o/470 Supldeme~02/gS) For Technical Amlstan~e: Sle/322-se6o ~ate of California