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Officeholder and Candidate Typeo, print inlnk. SHORT FORM <br />Campaign Statement -- Short Form OateStemp <br />(Government Code Sechon 84206) <br /> <br /> For Officiel Use Only <br />For use by officeholders and candidates who do not have a controlled committee and who do not anticipate <br />receiving $1,000 or more in contributions and do not anticipate spending $1,000 or more during the <br />calendar year. Officeholders whose salary is less than $100 per month and judges who have a controlled <br />committee may use this form under certmn circumstances. See the Information Manual on Campaiqn <br />Disclosure Provisions of the Political Reform Act for Elected Officeholders, Candidates, and Their Controlled <br />Committees for further information. <br /> <br />I Statement Covers Calendar Year 19 <br />II Officeholder or Candidate Information III Information on Office Sought or Held <br /> <br />IV Committee Information <br /> List ~11 commitlee~ of which you have knowl~ge that ~ primarily form~ lo receive contri~lions or to m~ke expe~i~ on ~half of ~r ca~idacy. <br /> <br />V Ve~ificalion <br /> I dedare under ~enalt¥ of perjury that to the best of m~ knowled~e~ I anticipate that I wiU receive less ~han $1 000 an~ ~hs~ I ~ill ~n~ ~es~ ~an $ 1.000 dufin~ <br /> California that the ~oregoing is true and correct. ' <br /> <br /> -- DATE SIGNATU~ OF ~FgE~R O~IDATE <br /> State ~ California Fair Political Pra~lces Commission <br /> <br /> <br />