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Officeholder and Candidate <br /> Campaign Statement Date Stamp CALIFORNIA 470 <br /> Form 470 Supplement El Amendment (Explain Below) FORM <br /> SUPPLEMENT <br /> For Official Use Only <br /> SEE INSTRUCTIONS ON REVERSE <br /> This form is written notification that the officeholder/candidate listed below has received contributions totaling$2,000 or more or has <br /> made expenditures of$2,000 or more during the calendar year. <br /> 1. Officeholder or Candidate Information <br /> NAME OF OFFICEHOLDER OR CANDIDATE <br /> STREET ADDRESS <br /> • <br /> CITY STATE ZIP CODE <br /> AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX/E-MAILADDRESS <br /> 2. Office Sought <br /> OFFICE SOUGHT DISTRICT NUMBER <br /> (IF APPLICABLE) <br /> DATE OF ELECTION(MONTH,DAY,YEAR) <br /> 3. Date Contributions Totaling $2,000 or More Were Received or Date Expenditures of$2,000 or More Were Made <br /> (MONTH,DAY,YEAR) <br /> FPPC Form 470/470 Supplement(Jan/2016) <br /> FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br /> www.fppc.ca.gov <br />