HomeMy WebLinkAboutForm 470 Jerry Clay 063009Y
Officeholder and Candidate SHORTFORK
or print iri ink.L'E I VE
Campaign Statement— ' - 1
Short -Form
Date of election if applicable: Amendment (Explain Below For Official Use Only
(Government Code Section 84206) ( p ) J U L 3 1 ��fnn
(Month, Day, Year) Lll�9
CITY OF ATASCADRO
CITY CLERK'S OFFI E
1., Statement Covers Calendar Year 20 09
2.° Officeholder or Candidate Information 3. Office Sought or Held
- ,Y
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
Jerry L. Clay Sr. City Council. Member
STREET ADDRESS JURISDICTION (LOCATION) DISTRICT NUMBER
(IFAPPLICABLE)
City of'Atascadero
CITY STATE ZIP CODE
Atascadero CA -93422
AREA CODE/DAYTIME PHONE NUMBER' OPTIONAL: FAX/E-MAIL ADDRESS
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. NUMBER COMMITTEE ADDRESS NAME OF TREASURER
N/A
N/A
5. Verification
I declare under penalty of perjury'that to the best of my knowledge I anticipate that I will receive less than $1,000 and that I will spe less an $1,000 during the
calendar year and.that I have used all reasonable diligence in preparing this statement. I c 7nder penalty of perjury der t e w of he State of California
that the foregoing is true and correct.
Executed on 7/31/09 By ..
DATE I ATUR F OFFICEHOLDER OR CANDIDATE
FPPC Form 47 4T0 Supplement (January/05)
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