Pruitt 470Officeholder and Candidate
Cary p.ai
Shoft.F orm
(Government Code Section 84206
T or print in ink.
Date of election if applicable:
Month, Da Year)
0 Amendment (Explain Below
Date Stamp
SHORT FORM
For Official Use Onl
I.. Statement. Covers Calendar Year 20
n oration
2W dIfficeholder.or.candidate m
3. Office Sou o r Held
NAME OF -OFFICEHOLDER OR CANDIDATE
OFFiCE SOUGHT OR HELD
N
STREET ADDRESS N
JURISDICTION (LOCATION)
&P"W- Ilk
DISTRICT NUMBER
IF APPLICABLE)
*4 N I
.CITY STATE
"ka
ZIP CODE.
AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX/ E-MAIL ADDRESS
C. rnm itt.
4. o ee.information:
List all committees 0 f. wh ich y o u ha kn o Me d ethat are p rimaril y fo rm e d to receive contributions or to m a ke. expen diture S. 0 n. b eh alf 6. f y our. candidac
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COMMITTEE NAME AND :1.D. NUMBER
COMMITTEE A DDRESS.��
NAME OF TREASURER.
Y 'Rz
5... verification
.that will receive:less than $1;000 and that I will spend less.thar) $1,000 durin the
.1 declare under p en a lt a best y e f knowled 1.:a icip at that l
'jur that t o the ate ws: e
calendar y ear. and that] have used all reasonable dili this statement. I..certif under penalty per under the ofth State of Ca
that the foregoing is true and :correct:
Executed on N�Ae��'
U. DATE
B
S1 ATURE F OFFICEHOLDER OR CANDIDATE
FPPC Form 470/470 Supplement. (Januar
7.
FPPC.Toll-Free Helpline: .866/ASK-FP.PC (866/275-3772)