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Officeholder and Candidate FOR~ 470SUPPLEMENT <br />Campaign Statement O,teStamp <br />Form 470 Supplement <br />(Government Code Section 84206) Type or print in ink. <br /> For Official Use Only <br />SEE INSTRUCTIONS ON REVERSE <br /> <br />This form is written notification that the officeholder/candidate listed below has received contributions <br />totaling $1,000 or more or has'made expenditu'res of $1,000 or more during the calendar year. <br /> <br /> I Officeholder or Candidate Information <br /> <br /> HAME OF OFFICE HOLDER OR CANDIDATE <br /> <br /> RESIDENTIAL OR BUSINESS ADDRESS (NO, AND STRE ET) <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 /> ~F APPLICABLE) <br /> <br /> DATE OF ELECTION (MONTH, DAY, YEAR) <br /> <br /> II <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 />