HomeMy WebLinkAboutGOMEZ 470 10/05/10MEN
Officeholder and Candidate l0
Campaign Statement - Type or print in ink.
Short Form
(Government Code Section 84206) Date of election N applicable: 0 Amendment (Explain Below)
(Month, Day, Year)
onki,. 0?, a010
1. Statement Covers Calendar Year 20 ~La_ .
2. Officeholder or Candidate Information 3. Office Sought or Held
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
~uvh~prly G6mez c1: Yd
STREETADDRESS JURISDICTION OCATION) IDISTRICT NUMBER
(IF APPLICABLE)
. (-
CITY STATE ZIP CODE
&
AREACODE/DAYTIME PHONE NUMBER OPTIONAL: FAX / E-MAIL ADDRESS
4. 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
FORM
Date Stamp
L Ot1 O O^ For Official Use Only
12.28
NAME OF TREASURER
J
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5. 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 Califomia
that the foregoing is true and correct.
Executed on C~-f . 05 . ;wc> By
DATE
SIGNATURE OF OF,-Ft%OLDER OR CANDIDATE
FPPC Form 4701470 Supplement (January/08)
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