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¢I'-: SHORT FORM <br /> Officeholder and Candidate Typeffl~ntlnlnk <br /> <br /> Campaign Statement -- Short Form <br /> (Govcfluncnt Code Scction 84206) A Fo~ Official Uso Only <br /> For usc by officeholders and candidales who do nol have a conu;olled commillee and who do not anticipate rec¢ivin~A <br /> $10130 or more in conuibmions and do not anticipate spcnding $1000 or morc during thc cntirc calendar year. <br /> Offr.~.holdcrs whose salary is Icss than $100 pcr month and judges who havc a conlmllcd commiltcc may usc this form <br /> under ccflain circumslanccs. Scc thc appropriate Informalion Manual on Campaign Disclosure Provisions of Ihc <br /> Polilical Reform Act (Manual A) for further information. <br /> <br /> Statement cove~ Calendar Year 10 ~ ~7/ · <br /> I Oflice~lder or Candidate Infection II Infarction on Office Held or ~ht <br /> <br /> ~N~ ~ ~SS ~: (~. ~ S~ET) ~ (L~T~) I ~ST~T ~fl (IF A~E) <br /> <br /> III ~Jll~ I~1~11~ <br /> List all co.flees of w~ch you kve kwledge tkt are pri~rily for~d to receive contributio~ or to ~e ape~it~es on beklf of ~ can~acy. <br /> <br /> C~nEE ~ME AND I.D. NUMAR C~MInEE AD~E~ ~ ~ TR~SURER <br /> <br /> IV Verification <br /> !dcclarc under penalty of perjury thru to thc best of my knowlcdgc, I anticipate Ilmt ! will receive less than $1000 and that ! will spend Icss than $1000 during thc calendar ycar <br /> and thai !havc uscd all rcasonablc diligcncc in prcpnring this slatcmcm. I ccrdfy unde~ pcnally of perjury undcr Ibc laws of thc Statc of California thai thc forcgoing is linc and <br /> <br /> : ~ . ~ ~ ~- , <br /> <br />--i <br /> <br /> lille el Calilemla Fell Nlilkel Pr&cli~e C~i~le~. <br /> <br /> <br />