HomeMy WebLinkAbout470 07/28/2003 Officeholder and Candidate Campaign Statement - Short Form 2003 John H LarsonOfficeholder and Candidate
Campaign Statement —
Short Form
(Government Code Section 64206)
Type or print in ink.
Date of election it applicable: I El Amendment (Explain Below)
(Month, Day, Year)
1. Statement Covers Calendar Year 20E2,_
Dale Stamp
2. Officeholder or Candidate Information 3. Office Sought or Held
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
JoHA H. L NRSON
STREET ADDRESS
CITY STATE ZIPCODE
';�
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
NC>06
COMMITTEE ADDRESS
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 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 Jul q 7—
DATE
By
OFFICEHOLDER OR CANDIDATE
FPPC Form 450 (June /01)
FPPC Toll -Free Helpline: 866 /ASK -FPPC