Kearney 470Officeholderand Candidate
Cam pa i n. Statement
ShortForm
(Government Code Section 84206)
SHORT FORM
T or print in ink.
Date of election if applicable:
(Month, Da Year)
Date Stamp
F1 Amendment (Explain Below For Offidal. Use Onl
P-N
AU6 3 9 2010
GF 10
kai
VA E R�rt
e
ORO
NAME. OF OFFICEHOLDER OR CANDIDATE k
STR ET ADDRESS
OCD
OFFICE SOUGHT H
J U R CT fl N CATION) DISTRICT NUMBER
(IF APPLICABLE)
CITY STATE ZIP C E
f :A elp
L `S
AREA CODE/DAYTIME P U R 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
5, Verification
I declare under penalt of.perjur to the best of m knowled I anticipate that I will receive less than $1 000 .and that I will spendl
9
calendar y ear.and that I have used all reasonable dili in preparin this statement. I certi .under .pena of per under theU
that the fore is true and correct.
F-ye cute d on BV
DATA SIGNATURE OF OFFICEHOLDER OR CANDIDATE
5jhan $1 000.durin the
of the State of California
FPPC Form 4701470 -IlUipplernent (Januar
FPPC Toll-Free Helpline: 86(->1XSK-FPPC (866/275-3772)
Officeholder and Candidate
Campai Statement
Form 470 Supplement
(Government Code Section 84206)
SEE INSTRUCTIONS ON REVERSE
This form is written notification that the off ceholder/candi date listed below has received contributions totalin
$1 000 or more or has made expenditures of $1,000 or more durin the calendar y ear.
DATE OF ELECTION (MONTH, DAY, YEAR)
FORM 470 SUPPLEMENT
For Official Use Only
MONTH, DAY, YEAR)
T or print in ink
Date Stamp
Amendment (Explain Below)
FPPC Form 4701470 Supplement (Januar
FOPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772)