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Officeholder and Candidate <br /> Campaign Statement- Date Stamp CALIFORNIA 470 <br /> Short Form FORM <br /> Date of election if applicable: El <br /> RECEIVED For Official Use Only <br /> (Month,Day,Year) Amendment (Explain Below) <br /> JUL 2 5 2024 <br /> OFF ICF nF TI-IF <br /> CITY CLERK <br /> 1. Statement Covers Calendar Year 20 . <br /> 2. Officeholder or Candidate Information 3. Office Sought or Held <br /> NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD <br /> �'�fc ll o be (41 --77ze s-titre r <br /> STREETADDRESS JURISDICTION(LOCATION) DISTRICT NUMBER <br /> -- <br /> (IF APPLICABLE)G� <br /> CITY STATE ZIP CODE <br /> Col m CA- 9)-3 )-y <br /> AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX/E-MAIL ADDRESS <br /> <br /> 4. Committee Information <br /> List all committees of which you have knowledge that are primarily formed to receive contributions or to make expenditures on behalf of your candidacy. <br /> COMMITTEE NAME AND I.D. NUMBER COMMITTEE ADDRESS NAME OF TREASURER <br /> • <br /> 5. Verification <br /> 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 •:nd less than$2,000 during the calendar year and that I have used <br /> all reasonable diligence in preparing this statement. I certify under penalty of perjury under the laws of the State of California the foregoing is true and correct. <br /> 'VS; l'07/(-/ <br /> Executed on By d <br /> DATE <br /> SIGNATURE OF OFFICEHOLDER OR CANDIDATE <br /> FPPC Form 470/470 Supplement(Jan/2016) <br /> FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br /> www.fppc.ca.gov <br />