Kearney 460ego der and Candidate
Campai Statement
Short Form
(Government Code Section 84206)
SHORT FORM
T or print in ink.
Date of election if applicable: I EJ Amendment
(Month, Da Year
J 1 �D/2°
i. Statement Covers Calendar Year 201.2::�.
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For Official Use Onl
CITY STATE ZIP CODE
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AREA CODE/DAYTIME PHONE NUMBER OPTIONAL. F I E&AIL ADDRESS
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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 COMM ITTEE ADDRESS NAMP r1P TPr:A-q1 IPPP
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N' M
I declare under penalt of per that to the best of m knovAed I anticipate that I will receive less than x$,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 und of perjur under the,,Ja softhe State of California
that the fore is true V nd correct.
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Executed on B
DATE SIGNATU OF OFF1 CE HOLDE RAR CANDIDATE
FPPC Form 4701470 Supplement (Januar
FPPC Toll-Free Helpline: 8661ASK-FPPC (8661276-3772)
Offi ceholder and Candidate
Campai Statement
Form 470 Supplement
(Government Code Section 84206)
Type or print In Ink.
Date Stamp
El A mendment (Ex Bel
FORK[ 470 SUPPLEMENT
SEE INSTRUCTIONS ON REVERSE
This form is written notification that the off ceholder /candidate listed below has received contributions totaling
$1 ,000 or more or has made expenditures of $1,000 or more during the calendar yeah.
NAME OF OFFICEHOLDER OR CANDIDATE
STREET ADDRESS
CITY
STATE ZIP CODE
AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX 1 E -MAIL ADDRESS
2 Office Sought
OFFICE SOUGHT DISTRICT NUMBER
(IF APPLICABLE)
uHI C Vr- ti-CV 1 1UN (MUNI H, UAY, YEAR)
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(MONTH, DAY, YEAR)
For official Use Only
V�kl<C
F'PPC Farm 4701470 supplement (January /08)
FPPC Toll-Free Helptlne: 8661AS FPPC (8661275.3772)