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Officeholder and Candidate FORM 470 SUPPLEMENT <br />Campaign Statement Date Stamp <br />Form 470 Supplement <br />(Government Code Section 84206) <br /> Type or print in ink. <br /> For Official Use Only <br />SE[ INSTRUCTIONS ON REVERSE <br /> <br />This torm is writlen notification that the officeholdedcandid,,te listed below has received contributions <br />totaling $1,000 or more or has'made expenditures of $1,000 or more du~ing the calendar year. <br /> <br /> I Officeholder or Candidate Information <br /> <br /> NAME OF OFFICEHOLDER OR CANDIDATE <br /> <br /> RESIDENTIAL OR BUSINESS ADDRESS (NO. ANi) 5 I REE~) <br /> <br /> CITY STATE ZIP CODE <br /> <br /> AREA CODE/DAYTIME PHONE NUMBER <br /> <br />II Information on Office Sought <br /> <br /> OFFICE SOUGHT DISTRICT NUMBER <br /> (IF APPLICABLE) <br /> <br /> DATE OF ELECTION (MONTH, DAY, YEAR) <br /> <br />III Date Contributions Totaling $1,000 or More Were Received or Date Expenditures of $1o000 or More Were Made <br /> <br /> (MONTH, DAY, YEAR) <br /> <br /> <br />