HomeMy WebLinkAbout1994 Officeholder and Candidate Type or print in Ink. SHORTFORM
Campaign Statement — Short Form Date Stamp
(Government Code Section 84206)
D LECE� V For Official Use Only
For use by officeholders and candidates who do not have a controlled committee and who do not anticipate
receiving $1,000 or more in contributions and do not anticipate spending S 1,000 or more during the
calendar year. Officeholders whose salary is less than $100 per month and judges who have a controlled
committee may use this form under certain circumstances. See the Information Manual on Cam ai n MAY 2 3 1994
Disclure Provisions of the Political Reform Act for Elected Officeholders. Can I ates an T eIr Controlled
omml or further information.
JZ-
I Statement Covers Calendar Year 19 at `'f
DSficeholder or Candidate Information III Information on Office Sought or Held
E OF OFFICEHOLDER OR CANDIDATE SOUGHT OR HELD
DS)P, Ll_ �.o u, C:" I Yh f- -e r'
.RESIDENTIAL OR BUSINESS ADDRESS (NO. AND STREET) JURISDICTION (LOCATION DISTRICT NUMBER
(IF APPLICABLE)
CITY STATE ZIP CODE DATE OF ELECTION (MONTH, DAY, YEAR) (IF APPLICABLE)
C-
AREA CODE /DAYTIME PHONE NUMBER
IV Committee Information
List all committees of which you have knowledge that are primarily formed to receive contributions or to make expenditures on behalf ofyour candidacy.
CO MMITTEE M AND I.D. MBER - COMMITTEE ADDRESS NAME OF TREASURER
V Verification
I declare under penalty of perjury that to the best of my knowledge, I anticipate that I will• eive less than f 1,000 and that I will spend less than $1,000 during
the,calendar year and that I have used all reasonable diligence in preparing this statement. I ertify under penalty of perjury under the laws of the State of
California that the foregoing is \ rue and Correct.
Executed On ° \C19 „ L `"�- By
W CITY AND STA TE SIGNATURE �OE \' OFFICEHOLDER OR CANDIDATE
FOR INFORMATION REOUIRED TO EE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT Or 1977, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE FOLONAL REFORM Act
State of California Fair Political Practices Commission
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