HomeMy WebLinkAbout470 01/07/2002 Officeholder and Candidate Campaign Statement - Short Form 2001 John H LarsonOfficeholder and Candidate
Campaign Statement —
Short Form
(Government Code Section 84206)
Type or print in ink.
Date of election if applicable: I Amendment (Explain Below)
(Month, Day, Year)
1. Statement Covers Calendar Year 20 01
2. Officeholder or Candidate Information 3. Office Sought or Held
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
JC)"Q I-I. I_AiZSC)Q
STREET ADDRESS
CITY
& ('
AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX /E -MAIL ADDRESS
Dale
7 'r) ial Use Only
S r/y o 2
FORM
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
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 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 _�r`l")a Q"� �4 'Z(:7J2
GATE
By �
IGLDER OR CANUIDALG
FPPC Form 450 (June /01)
FPPC Toll -Free Helpline: 866 /ASK -FPPC