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Officeholder and Candidate <br /> Campaign Statement— Date <br /> CALIFORNIA 470 <br /> Short Form FORM <br /> Date of election if applicable: ❑ _Amendment (Explain Below) 9 For Official Use Only <br /> (Month,Day,Year) JUL 2 5 2024 <br /> OFFICE OF THE <br /> CITY CLERK <br /> 1. Statement Covers Calendar Year 20 2`t <br /> 2. Officeholder or Candidate Information 3. Office Sought or Held <br /> NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD <br /> &I f o t ' ---(Th svi,fe r <br /> STREET ADD ESS JURISDICTION OCATION) DISTRICT NUMBER <br /> <br /> / STATE ZIP CODE f <br /> Q o (-0 IQ 1 y3 Z� <br /> AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX I E-MAILADDRESS <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 /> 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 wil pend 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 Californ': aat the g in t correct. <br /> • )717— <br /> Executed on By <br /> DATE 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 />