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Officeholder and Candidate <br />Campaign Statement - <br />Short Form <br />1. Statement Covers Calendar Year 20 <br />Date of elecdon If applicable: <br />(Month, Day, Year) <br />2. Officeholder or Candidate Information <br />NAME OF OFFICEHOLDER OR CANDIDATE <br />Shelly Masur <br />STREETADDRESS <br />440 Birch Street <br />CITY <br />Redwood City <br />AREACODEDAYTIME PHONE NUMBER <br />650-614-0349 <br />17 <br />STATE ZIPCODE <br />cnm1a �,i I ' I <br />RECEIVE I'Lrj W <br />Amendment (Explain Bebw) For, ficial Usecny <br />JUL 31 20 7 <br />Citv of Redwood amity <br />City Clerk <br />3. Office Sought or Held <br />OFFICE SOUGHT OR HELD <br />CA 94062 <br />OPTIONAL. FAX/E-MAILADDRESS <br />Councilmember <br />JURISDICTION (LOCATION) <br />Redwood City <br />DISTRICTNUMBER <br />(IFAPPLICABLE) <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 COMMITTEE ADDRESS NAME OF TREASURER <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 $2 ,000 and that I will spend less than $2,000 during the calendar year and that I have <br />used all reasonable diligence in preparing this statement. I certify under penalty of perjury under the laws of the Slate of California that the foregoing is true and correct. <br />Executed on 3 ) ! f 4 By �/ � ` A `^is� `'/�\ <br />DATE SIGNATURE OF OFFICEHOLDER OR CANDIDATE <br />-Clear Form I I .:PrintTorm. <br />FPPC Form 470/470 Supplement (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (66612753772) <br />www.fppc.ca.gov <br />