HomeMy WebLinkAboutROBINSON 470 fficeholder and Candidate
Campaign Statement -- Short Form
(Government Code Section 84206)
Type or print in ink.
Date Stamp
For use by officeholders and candidates who do not have a controlled comm ttee 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 j~'~ges who have a controlled
committee may use this form under certam circumstances. See the lnformation Manual on CamDaicln
Disclosure Provisions of the Political Reform Act for Elected Officeholders, Candidates, and Their Controlled
Committees for further information.
I Statement Covers Calendar Year 19
SHORT FORM
For Official Use Only.
II Officeholder or CandidAte Information III Information on Office Sought or Held
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
jURiSDiC~ON C~ 0~ ~ i ~
RESIDENT~L OR BUSINESS ADDRESS (NO AND STREET) (LOCATION) DISTRICT NUMBER
CITY STATE ZIP (ODE ~ATE OF ELE(TION (MONTH, DAY, YEAR) (IF APPLI~BLE)
~oV-~ ~>- 7>~
AREA ~ODE/DAYTIM~ PHONE NUMBER
!',4 u v 7//~,.~>
IV
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 TREASUI~Efl
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. /,~
DAlE CITY AND STATE SlGNAIU~ O~ ~FKEHOLDER OR CANDIDAVE
FOR INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANt TO THE INFORMATION PRACTICES ACT OF 1977. SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF .THE POLITICAL REFORM ACT
State of California Fair Political Practices Commission