HomeMy WebLinkAboutForm 470 Newsom 063021Officeholder and Candidate
Campaign Statement —
Short Form
Date of election if applicable;
(Month, Day, Year)
110 a.c� 1�
1. Statement Covers Calendar Year 24 1z ( .
2. Officeholder or Candidate Information
NAME F OFFIC�ENOLDER OR CANDIDATE
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11 Amendment (Explain Below)
OPTIONAL: FAX l E-MAIL ADDRESS
3. Office Sought or Held
JU
CLU
Date Stamp
RECEIVE
F 2021
CITY OF ATASCADE
CITY CLERK'S OFFI
For Official Use Only
DISTRICT NUMBER
{IF APPLICABLE;
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- NUM6ER 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 0I��
DATE
3y
SIGNATURE OF OFFICEHOLDER OR CANDIDATE
FPPC Form 4701470 Supplement (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (8661275-3772)
www.fppc.ca.gov