HomeMy WebLinkAboutHOLMES PREELEC98(2) fficeholder and Candidate Typ. or print in ink.
Campaign Statement- Short Form
(Government Code Section 84206)
For use by an officeholder, 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 Campaign Disclosure
Provisions of the Political Reform Act for Elected Officeholders, Candidates, and Their Controlled Committees
for further information.
I Statement Covers Calendar Year 19 .r'¢oC/,
II Officeholder or Candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
ESS ADDRESS (NO. AND STREET)
AREA CODE/DAYTIME PHONE NUMBER
7 - d9
ZIP CODE
Date Stamp
F!L E COP Y
SHORT FORM
F,~r Official Use Only' '-~
III Information on C)~fCme Sought or ~ieii:l
oFncE souGHT oR HELD .......::~r ;EL.D C~'F¥ CLERK
J I LO
DISTRICT NUMBER
DATE OF~ECTION (MONTH, DAY, YEAR) (IFAPPLICABLE)
'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 NAMEAND LD. NUMBER COMMITTEEADDRESS NAME OFTREASURER
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. . . , r.~f~Z,Z/~
DATE SIC URE OF OFFICEHOLDER OR CANDIDATE
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 ACI
State of California Fair Political Practices Commission
:
~ ,Z::: TF
/501
Ill IIIII . "~