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SHORT FORM <br />Officeholder and Candidate <br />Campaign Statement -- Short Form <br />(C~OViIllmeitl Code Stq:t Jo~ ~ ~06) A Fo~ Ol~cla~ Use Only <br /> <br />$1000 ~ ~o in ~i~fi~ ~ ~ ~ anfici~m s~ing or m~ d~ng y~. <br /> <br />O[F~I~ w~ ~ is ~ ~ $1~ ~r mon~ <br />~f c~n c~s. ~ ~ a~o~e Inf~ati~ Manual on Cam~ien Di~l~ure ~ovisi~s of the <br />~lil~M Rcf~ Act (M~ A) fm [u~r inf~. <br /> <br />I ~ce~r or C~i~te Info~ II Info~tion on Olfice Held or ~ht <br /> <br /> List ~1 co.trees of w~h ~ ~ve ~w~dge t~t =e pri~rily for~d ~ receive contributio= or = ~e ex~itures on ~ of ~= ca~cy. <br /> <br /> C~nEE ~ AND LO. NUMAR C~nEE AD~E~ ~ ~ TR~SURER <br /> <br /> IV Verification <br /> I declare undo= penalty of perjury I1~ to thc besl el' my knowledge, 1 nn6cipae that I will seceivc less than $1000 and Ihat I will spend I~ss {hah $1000 dining the calendar year <br /> nnd ~ I have used nil ~J,=nnablc diligence in Ixcpnring this ,~,-menL I ceJlify under penally o1' perjury under thc laws of the Slalc of California that the foregoing is ~ and <br /> <br /> Slate of Callicmla Fair Po#ticd Practices Comndssicn. <br /> <br /> <br />