HomeMy WebLinkAboutRUSSO PREELEC00(2) fficeholder and Candidate
Campaign Statement -- Short Form
(Government Code Section 84206)
Type or print in ink.
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 $1,000 or more during the
calendar year. Officeholders whose salary is less than $100 per month and judges who have a controlled
committee may use this form under certain circumstances. See the Information Manual on Campaiqn
Disc~~sure Pr~visi~ns ~f the P~~itica~ Ref~rm Act f~r Elected Officeh~~ders~ Candidates~ and Their C~ntr~ ed~
Committees for further information.
I Statement Covers Calendar Year lg 2cDc') .
Date Stamp
JAIN 2'/ ?l'l b: 28
ER~FiF1 [, r.;-"
........ I ?
SHORT FORM
For Official Use OnlX
II Officeholder or Candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
RESIDENTIAL OR BUSINESS ADDRESS ~. (NO AND STREET)
CITY STATE ZIP CODE
/,)REA CODE/DAYTIME PHONE NUMBER
III Information on Office Sought or Held
OFFICE SOUGHT OR HELD
JURISDICTION (LOCATION)
DISTRICT NUMBER
(IF APPLICABLE
DATE OF ELECTION (MONTH, DAY, YEAR) (IF APPLICABLE)
IV Committee Information
List all committees of which you have knowledge that are primarily formed to receive contributions or to make ex
(~OMMITT~I[ NAM[ ANp LD NVMR~R COMMITTEE ADDRE$~
V
aenditures on behalf of your candidacy.
NAME OF TREASURER
Verification
I declare under penalty of perjury that to the best of m~. knowledge, I anticipate that I will re_~eL~e less than $/~,0( and that I will spend less than $1,000 during
the calendar year and that I have used all reasonable ddigence in preparing this statement. ~ce~ify under Pl~nal, f of perjury under the laws of the State of
California that the foregoing is true and correct.
0
State of California Fair Political Practices Commission
Officeholder and Candidate
Campaign Statement
Form 470 Supplement
(Government Code Secbon 84206)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
This form is written notification that the officeholder/candidate listed below has received contributions
totaling $1,000 or more or has made expenditures of $1,000 or more during the calendar year.
I Officeholder or Candidate Information
Date Stamp
FORM 470 SUPPLEMENT
For Official Use Only
NAME OF OFFICEHOLDER OR CANDIDATE
RESIDENTIAL OR BUSINESS ADDRESS
CITY
(NO, AND STREET)
STATE ZIP CODE
AREA
II Information on Office Sought
OFF~ESOUGHT
DATE OF ELECTION (MONTH, DAY, YEAR)
DISTRICT NUMBER
(IF APPLICABLE)
III Date Contributions Totaling $1,000 or More Were Received or Date Expenditures of $1,000 or More Were Made
(MONTH, DAY, YEAR)