HomeMy WebLinkAboutMBAGWU 470 10/14/10Officeholder and Candidate
Campaign Statement -
Short Form
(Government Cade Section 84206)
Type or print in ink.
Date of election N applicable:
(Month, Day, Year)
[7-110
1. Statement Covers Calendar Year 20 -~-O .
❑ Amendment (Explain Below)
Date Stamp
FORM
For Official Use
2010 OCT 14 IPM 3: 28
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2. Officeholder or Candidate Information
. OF OFFICEHOLDER OR CANDIDATE
I ( t~'z m~ --STREET
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3. Office Sought or Held
LA Y\-C,( t
JURISDICTION (LOCATION) DISTRICT NUMBER
D1 (IFAPPLICABLE)
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 I COMMITTEE ADDRESS I NAME OF TREASURER
5.
Verification
I declare under penalty of perury that to the best of my knowledge I anticipate that I will receive less than $1,000 and that I will spend les&4haR$3,W
calendar year and that I have used all reasonable diligence in preparing this statement. I certify under a of perjury under the laws of the State
that the foregoing i true and correct.
Executed on 1 V zs g
v
DATE SIGNATURE OF OFFICEHOLDER NDIDATE
during the
X701470 Supplement (January/08)
Helpline: 8661ASK-FPPC (86612753772)
2010 OCT 14 PM 3: 28
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