HomeMy WebLinkAboutHOLMES PREELEC98(1) 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 corem tree and who do not anticipate
receiving $1,000 or more in contributions and do not anticipate spend ng $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 Campaicln
Disclosure Provisions of the Political Reform Act for Elected Officeholders, Candidates, and Their Controlled
Committees for further information.
I Statement Covers Calendar Year19 ~' .
Date Stamp
FILl?
SHORT FORM
For Official Use Onl~
II
Officeholder or Candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
R R BLISINESS ADDRESS (NO ANDSTREET)
CITY STATE ZIP CODE
AREA CODE/DAYTIME PHONE NUMBER
III
Information on Office Sought or Held
OFFICE SOUGHT OR HELD
JUR~SD~CTIO~ (LOCATION)
DATE OF ~ECTION (MONTH, DAY, YEAR) (IF APPLI~BLE)
DISTRICT NUMBER
(IF APPLICABLE)
7
IV Committee Information
List all committees of which you ha ve 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 TREASURER
V
Verification
I declare under penalty of peri ury that to the best of m)( knowledge i ant c pate that I wil rece ve ess than $1,000 and that I will spend less then $1,000 during
the calendar year and that I have used all reasonable ddigence in prepar ng this statementcertify under penalty of perjury under the laws of the State of
California that the foregoing is true and correct.
[HOLDER OR ~NDIDATE
State of California Fair Political Practices Commission