Annual 470 Council
Officeholder and Candidate
Campaign Statement -
Short Form
(Government Code Section 84206)
Type or print in ink.
JUL 1 2 2006
Date of election if applicable: 0 Amendment (Explain Below)
(Month, Day, Year)
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CUPERTINO CITY LERK
1. Statement Covers Calendar Year 20 0 lu .
2. Officeholder or Candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
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STREET ADDRESS
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3. Office Sought or Held
OFFICE SOUGHT OR HELD
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JURISDICTION (LOCATION)
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DISTRICT NUMBER
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CITY
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AREACOD8DAYnME PHONE NUMBER
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4. Committee Information
List all committees of which you ha ve knowledge that are primarily formed to receive contributions or to make expenditures on behalf of your candidacy
COMMITTEE NAME AND 1.0. NUMBER COMMITTEE ADDRESS NAME OF TREASURER
STATE ZIP CODE
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OPTIONAL: FAX I E-MAIL ADDRESS
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5. Verification
I declare under penalty of perjury that to the best of my knowledge I anticipate that I will receive less 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 perjury under the laws of the State of California
that the foregoing is true and correct. Q. ~
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Executed on ' \ J, ~ l...A . 1...0 By-------= ./
\ DATE SIGNATURE OF OFFICEHOLDER OR CANDIDATE
FPPC Form 4701470 Supplement (January/l
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-37'