HomeMy WebLinkAbout470 07/13/2004 Officeholder and Candidate Campaign Statement - Short Form 2004 John H LarsonOfficeholder and Candidate
Campaign Statement —
Short Form
(Government Code Section 84206)
Type or print in inlL
Date of election if applicable: ll Amendment (Explain Below)
(Month, Day, Year)
{�
1. Statement Covers Calendar Year 00-0
2. Officeholder or Candidate Information 3. Office Sought or Held
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
JOHO H. LA Q5C)4
STREETADDRESS
Data Stamp
For Official Use Only
(IFAPPLICABLE)
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
NAME OF TREASURER
FORM
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.
Executed on oi- IS — Dy
DATE
By
OR
FPPC Form 450 (June /01)
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