Kennedy 470Officeholder and Candidate
Campai Statement —
Short Form
( G overnment Code S ection 84206
T or print in ink.
Date of election if applicable: ❑ Amendment (Explain Below
(Month, Da Year)
1. Statement Covers Calendar Year 2® �C
R mael z W a Q V IT,
For Official Use Onl
Officeholder or Candidate Informatior,
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4
3. Office Sou or Heb",J
OFFICE SOUGHT OR HELD
JURISDICTI, N (COCA ION) DISTRICT NUMBER
(IF APPLICABLE)
AREA CODE/DAYTIME PHONE NUMBER
. .... . .... ......... ................. .. . ......................... . . .... .......... . . - -------------- -
OPTIONAL: FAX/ E-MAIL ADDRESS
4. Committee Information
List all committees of which y ou have knowled that are primaril formed to receive contributions or to make expenditures on behalf of y our candidac
COMMITTEE NAME AND I.D, NUMBER I COMMITTEE ADDRESS I NAME OF TREASURER
P 0 osie_�
... .... ... ....... ... ... . ....
5. Verification
I declare under penalt of perjur that to the best of m knowled I anticipate that I will receive less than $1 , 000 and that I will spend less than $1 , 000 durin the
calendar y ear and that I have used all reasonable dili in preparin this statement. I certif under p Malt of perjur under the laws of the State of California
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that the fore is trup and correct.
Executed on B
I DATE SIGNATU OF OFF] CE H OLDE R OR CANDIDATE
FPPC Form 470/47❑ Supplement (Januar
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