HomeMy WebLinkAboutSCRIVNER PREELEC04(2)ReciPient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Statement covers period
'rom 0 //01/200A
Date of election if applicable
(Month, Day, Year)
through 09/30/2004
Date Stamp
COVER PAGE
040CT-6 MIl: 31
Page 1 of 9
For Official Use Only
1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4.
Officeholder, Candidate Controlled Commitlee
O State Candidate Election Committee
O Recall
[] General Purpose Committee O Sponsored
C) Small Contributor Committee
C) Political Party/Central Committee
[] Ballot Measure Committee O Primarily Formed
O Controlled
O Sponsored
[] Primarily Formed Candidate/
Officeholder Committee
(ALSO Complete Pa~ 7)
3. Committee Information
I.D. NUMBER
1270512
COMMITTEE NAME(OR CANDIDATE'S NAMEIF NO COMMITTEE)
ZACK SCRiVNER for CITY COUNCIL
zscrivner,~iibertystar.net
2. Type of Statement: [] Preelection Statement
[] Semi-annual Statement
[] Termination Statement
[] Amendment (Explain below)
[] Quarterly Statement
[] Special Odd-Year Report
[] Supplemental Preelectien
Statement - Attach Form 495
Treasurer(s)
NAME OF TREASURER
ANDY STANLEY
MAILING ADDRESS
NAME OF ASSISTANT TREASURER, iF ANY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I
certify under penalty of perjury under the laws of t~e State of California that the foregoing is true and correct.
Executedon ./~ -- ~---- 0 L/
www. netfile, com
By
Signature of Controlling Officeholder Candidate State Measure Proponent
By
Signature of Controlling Officeholder Candidate StateMeasure Proponent FPPC Form 460 (JunelOl)
FPPC Ton-Free Helpline: 8661ASK-FPPC
State of California
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