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Officehoider and Candidate sHORrFORnn <br /> Call'lPalgll Stc'�t@Ill@Ilt— Type or print in ink. � `�°` T5a'�e 5famp � ' <br /> 4 Y��• ! • � <br /> Short Form � �"" � � <br /> (Government Code Section 84206) Date of election if applicable: � QCpgndtllellt (Explain Belo ) For o�icial Use only <br /> (Month,Day,Year) <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> JefF Ira Council, City of Redwood City <br /> STREETADDRESS - JURISDICT�ON(LOCATION) DISTRICTNUMBER <br /> {IF APPLICABLE) <br /> 333 Twin Dolphin Dr. Suite 230 <br /> ��7y STATE ZIP COOE <br /> Redwood City CA 94065 <br /> AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX/E-MAIL ADDRESS <br /> 650-802-8668 650-802-0866 <br /> 4. Committee Information <br /> List all committees of which you have knowledge thaf are primarily formed to receive contribufions 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 $1,000 and that I will spend less than $1,000 during <br /> the calendar year and that I have used all reasonable diligence in preparing this statement. I certify under penalty of perjury under the laws of the State of <br /> California that the foregoing is true and correct. <br /> Executedon �r3 �' ` � BY <br /> DATE S NATURE OF OFFICEHOLDER OR CANDIDATE <br /> FPPC Form 470 (Junel01) <br /> FPPC Toll-Free Helpline: 8661ASK-FPPC <br />