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FORM 470 SUPPLEMENT <br />Officeholder and Candidate <br />Campaign Statement <br />Form 470 Supplement <br />(Government Code Section 84206) Type or print in ink. <br /> For Official Use Only <br /> <br />SEE INSTRUCTIONS ON REVERSE <br /> <br />This form is written notification that the officeholder/candidate listed below has received contributions totaling <br />$1,000 or more or has made expenditures of $1,000 or more during the calendar year. <br /> <br /> Officeholder or Candidate Infm'mation * <br /> NAM.E OF OFFICEHOLDER OR CANDIDATE - ' <br /> <br /> RESIDENTIAL OR BUSINESS ADDRES~ (NO. AND STREI= I ) <br /> <br /> CITY STATE ZIP CODE <br /> <br /> AREA CODE/DAYTIME PHONE NUMBER <br /> <br /> II Information on Office ~ought <br /> OFFICE SOUGHT I DISTRICT NUMBER <br /> · ' I(IF APPLICABLE) . <br /> DATE OFELECTION (MONTH, DAY, YEAR) <br /> <br /> III Date Contributions Totaling $1,000 or More Were Received or Date Expenditures of $1,000 or More Were Made <br /> <br /> (MONTH, DAY, YEAR) <br /> <br /> <br />