HomeMy WebLinkAbout1993 SHORTFORM
Officeholder and Candidate Typo or Print In Mk Date Stamp 701ficial
(Government Statement — Short Form
(Govertent Cale Section 84206) D � i��. p
For use by Officeholders and Candidates who do not have a controlled committee and who do not anticipate receiving
ltJi v For
$1000 or more in contributions and do not anticipate spending $1000 or more during the entire calendar year.
Officeholders whose salary is less than $100 per month and judges who have a controlled committee may use this form ,JAN 28 1994
under certain circumstances. See the appropriate Information Manual on Campaien Disclosure Provisions of the
political Reform Act (Manual A) for further in formation. BQ
Statement covers Calendar Year lsaa .
Officeholder or Candidate Information 11 Information on Office Held or Sought
HAMS OF OFFICEHOLDER OR 7 OFFICE HELD OR SOUGHT,
�a�2tctA ��. �t2D
RE SIDENBAI. O`n1 BUSINESS ADDRESS: (NO. (
ANDD STREET) c /� �+ /� BISTflICT N
JURISDICTION ( LOCATION) UMBER (IF APPLICABI IT
CITY, STATE IIPCODE DATE OF ELECTION(MONTF, DAY, YEAR) (IF APPLICABI. E)
�C� l L:! �;� R- c Imo- C1 a S g
AREA CODETDAYrIME PRONE NUMBER
G o 9 - fo'1 6 - 0 C 2l-'
Ill 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
IV Verification
1 declare under penalty of perjury that to the best of my knowledge, l anticipate that I will receive less than $1000 and that 1 will spend less than $1000 during the calendar year
and that I have used all reasonable diligence in preparing this statement. l certify under penalty of perjury
correct. tin the laws of the State of California that the foregoing is True and
� ny
Executed art y Al \ y Yri By ��.. G��
DATE CITY AND STATE SIGNATURE OF OFNCET Vt DER OR CANDIDATE
FOR INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INFOnMATION MANI lAI ON CAMPAIGN DISCI OSI RFF PROVntc)N4OE THE EU ITICAI RFFORM ACT
Slats of California Fair Political Practices Commission.