470
Officeholder and Candidate
Campaign Statement -
Short Form
(Government Code Section 84206)
Type or print In Ink.
Date of election If applicable: 0 Amendment (Explain Below)
(Month, Day, Year)
JUL 1 1 2006
PERTINO CITY CLE K
1. Statement Covers Calendar Year 20 Db
.
2. Officeholder or Candidate Information
NAME OF ~FACEHOLDER OR C~NDIDATE
<i<\ C'^ CJ..A-ot ~ e V\~~ t
STREET ADDRESS
2 I b02. v: I ~ C\. M a. V"" ('eL C-r
3. Office Sought or Held
OFFICE SOUGHT OR HELD
C~ C c:)UI^L,' (
JURISDICTION (LOCATION)
C ~ O~ C..J ~'k.-!)
DISTRICT NUMBER
(IF APPLICABLE)
CITY
AR~~D~~~MBER
~ oct - Cf 7 ? - ~ f...{Cf y
STATE
ZIP CODE
qSVfY
Ct4
OPTIONAL: FAX I E-MAIL ADDRESS
4. Committee Information
Ust 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 NAME OF TREASURER
(11 f1A-t2- /
'-
5. Verification
I declare under penalty of pe~ury that to the best of my knowledge I anticipate that I will receive Jess 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 pe~ury under the laws of the State of
California that the foregoing is true and corict ~ ~ . /
Executed on 7 / I ( 06 By "\ ~/1 ~~./
DATE \.....::"" ~ SIGNATURE OF OFFICEHOLDER OR CANDIDATE
FPPC Form 450 (June/01)
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