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<br />Officeholder and Candidate <br />Campaign Statement - <br />Short Form <br />(Government Code Section 84206) <br /> <br />Type or print in ink. <br /> <br />SHORT FORM <br /> <br />Date Stamp <br /> <br />CALIFORNIA 470 <br />FORM <br /> <br />Date of election if applicable: 0 Amendment (Explain Below) <br />(Month, Day, Year) <br /> <br />For Official Use Only <br /> <br />/l/06101 <br /> <br />1. Statement Covers Calendar Year 20 siL- . <br />2. Officeholder or Candidate Information <br /> <br />JOY\ E:~V\ <br /> <br />'rJ \~I S~ VI <br /> <br />3. Office Sought or Held <br />OFFICE SOUGHT OR HELD <br />C it COl.)v\~'\ <br />JURISDICTI (LOCATION) <br /> <br />DISTRICT NUMBER <br />(IF APPLICABLE) <br /> <br />NAME OF OFFICEHOLDER OR CANDIDATE <br /> <br />L { f'S C\. \oQ.f- ~ <br />STREET ADDRESS <br /> €- <br />CITY <br />K.ed wooJ <br /> <br />STATE <br /> <br />ZIP CODE <br /> <br />c/'tJ ~ cA <br />AREA CODEIDAYTIME PHONE NUMBER <br />( ( <br /> <br />9.YD ros- <br /> <br />OPTIONAL: FAX I E-MAIL ADDRESS <br /> <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 /> <br />5. Verification <br /> <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 the <br />calendar year and that I have used all reasonable diligence in preparing this statement. I certify under penalty of perjury under the I ws of the State of California <br />that the foregoing is true and correct. <br /> <br />/0/15/07 <br /> <br />Executed on <br /> <br />By <br /> <br /> <br /> <br />DATE <br /> <br />SIGNATURE OF OFFICEHOLDER OR CANDIDATE <br /> <br />FPPC Form 470/470 Supplement (January/OS) <br />FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) <br />