HomeMy WebLinkAboutForm 470 Candidate Campaign Statement 07212022Officeholder and Candidate
Campaign Statement -
Short Form
1. Statement Covers Calendar Year 20
Date of election if applicable:
(Month, Day, Year)
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2. Officeholder or Candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
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3TREETADDRESS
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;ITY STATE ZIPCODE
❑ Amendment (Explain Below) I JUL 21 2022
CITY CLERK
'OF SEAL. BE
3. Office Sought or Held
IURISDIC (LOCAT N) DISTRICT NUMBER
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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 I . NUMBER I COMMITTEE ADDRESS I 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 $2 ,000 and that I will spend less than $2,000 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 _I/f 1�"/J;?,9:--,2 =.?, By
DATE
Clear Form Print Form
FPPC Form 470/470 Supplement (Jan/20'
FPPC Advice: advice@fppc.ca.gov (866/275-37�
www.fppc.ca.g