470 Annual
Officeholder and Candidate
Campaign Statement -
Short Form
(Government Code Section 84206)
Type or print in ink.
2 ~ r'Qn7
Jut; t: {l VI
Date of election if applicable: D Amendment (Explain Bel
(Month, Day, Year)
CU. ERTING CITY CLE K
1. Statement Covers Calendar Year 20 ~ .
2. Officeholder or Candidate Information
N\M<\O~~OJNDIDATL4w ~ ~ (
STREET ADDRESS
3. Office Sought or Held
OFFICE SOUGHT OR HELD
Cl'
JURISDICTI
C~
COw- C (
(LOCATION)
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DISTRICT NUMBER
(IF APPLICABLE)
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CITY
Cu
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STATE ZIP CODE
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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 LD. NUMBER COMMITTEE ADDRESS NAME OF TREASURER
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 prepClring this statement. I certify under penalty of perjury under the laws of the State of California
that the fOreg~ ;ue and correct. ~ ~.
E,~"d," . 2- J (0 7"" By ~ ~~,~~"
FPPC Form 470/470 Supplement (January/OS)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)