HomeMy WebLinkAboutMCCLAIN PREELEC00(2) fficeholder and Candidate
Campaign Statement--Short Form
(Government Code Sectioo 84206)
Type or print in ink.
For use by an officeholder, candidates who do not have a controlled committee and who do not an~p,.,a~2 '7
receiving $1,000 or more in contributions and do not anticipate spending $1,000 or more during the ca['e'h'da¥ '
year. Officeholders whose salary is less than $100 per month and judges who have a controlle(~,,.'~t~e.
may use this form under certain cimumstances. See the Information Manual on Campaian Disclosur~ '"" ~: L.?
Provisions of the Political Reform Act for Elected Officeholders, Candidates. and Their Controlled Committees
for further information.
I Statement Covers Calendar Year 19 .
II Officeholder or Candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
R~'SIDENTIAL OR BUSIN ESS ADDR ESS (NO. AND STREET)
AREA CODE/DAYTIME PHONE NUMBER
IV Commi~o Information
STATE ZIP CODE
Date Stamp
SHORT FO~'~ M
III Information on Office Sought or Held
OFFICE SOUGHT OR HELD
For Official Use Only
JURISDICTION (LOCATION) DISTRICT NUMBER
IFAPPLICABLE)
DATE OF ELECTION (MONTH, DAY, YEAR) (IF APPLICABLE)
List all committees of which you have knowledge that are primarily formed to receive contributions or to make expenditures on behalf of your candidacy
COMMITTEENAMEANDI.D. NUMBER
NAMEOFTREASURER
COMMITTEEADDRESS
V 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 spend less than $1,000 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. ~:)~~ , By -;'~'~~' z,~'~-~'~
Executed on //--DATE ~ ~- ~ At ~ AND STAT~ / ' SIGNATURE OF OFFICEHOLDER OR CANDIDATE
FOR INFORMATION REQUIRED TO BE PROVIOED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF ~HE POLITICAI,.~C~
State of California Fair Political Practices Commission
Officeholder and Candidate
Campaign Statement
Form 470 Supplement
(Government Code Sectio~ 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.
Date Stamp
FORM 470 SUPPLEMENT
For Official Use Only
I Officeholder or Candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
(NO. AND STREET)
DISTRICT NUMBER
DATE OF ELECTION (MONTH, DAY, YEAR)
III Date Contributions Totaling $1,000 or More Were Received or Date Expenditures of $1,000 or More Were Made
(MONTH, DAW YEAR)