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Officeholder and Candidate SHORT FORM <br />Campaign Statement- Type or print in ink. <br /> <br />Short Form ~ C ~ ~ ~ ~ <br />(Govemment Code Section 84206) Date of election if applicable: [] Amendment (Explain Be[ow) For Official Use Only <br /> (Month, Day, Year) SEP 3 0 2003 <br /> /]- Z/L - ~ ~,.~ CiTY OF REDWOOD CITY <br /> CITY CLERK <br /> <br />1. Statement Covers Calendar Year 20 <br /> <br />2. Officeholder or Candidate Information 3. Office Sought or Held <br /> NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD <br /> <br /> S~R~ET ADD~ESS ~U~IS~CTION (LOCATION) ' DISTRICT NUMBER <br /> CI~ STATE ZIP CODE <br /> <br /> AREA COD~DA~IME PHONE NUMBER OPTIONAL: F~ / E-MAIL ADDRESS <br /> <br />4. Committee Information <br /> List all committees of which you have knowledge that are primarily formed to receive contributions or to make expenditures on behalf of your candidacy. <br /> COMMITTEE NAME AND I.D. NUMBER COMMI3q-EE ADDRESS NAME OF TREASURER <br /> <br />5. Verification <br /> 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 <br /> 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 <br /> California that the foregoing is true and correct. <br /> <br /> DATE SIGNATURE OF OFFICEHOLDER OR CANDIDATE <br /> <br /> FPPC Form 470 (June/01) <br /> FPPC Toll-Free Helpline: 866/ASK-FPPC <br /> <br /> <br />