Mcmahon 460·-
Officeholder and Candidate
Campaign Statement -
Short Form
Type or print In ink. Date Stamp
SHORT FORM
CALIFORNIA 470
FORM
(Government Code Section 84206) Date of election if applicable: O Amendment (Explain Below)
(Month, Day, Year) ILE For Official Use Only
1. Statement Covers Calendar Year 20 ..a..:L .
2. Officeholder or Candidate Information
NAlllE OF OFFICEHOLDER OR CANDIDATE
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STREET ADDRESS
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ZIP CODE
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JAN 3 1 2005
CITY CLERK'S OFFICE
3. Office Sought or Held
OFFICE SOUGHT OR HELD
JURISDICTION (LOCATION)
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DISTRICT NUMBER
(IF APPLICABLE)
AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX/E·MAILADDRESS
4. Committee Information
List all committees of which you have knowledge that are primarily formed to receive contributions or to make expenditures on behalf of your candidacy.
COMMITTEE NAME AND 1.D. NUMBER COMMITTEE ADDRESS NAME OF TREASURER
5. Verification
I declare under penalty of perjury that to the best of my knowledge I anticipate that I will receive less than $1,000 and that I will spend less than $1,000 during
the calendar year and that I have used all reasonable diligence in preparing this statement. I certify under penalty of perjury under the laws of the State of
Calttomia that the foreg::s 9"e and com3ct. <. ~ _ /,?' ,, /??~ ~
Executed on 1/lj_(;Lo () J By __ ,..-:;;../-"'-~-..;;;....;;-------~----
FPPC Form 450 (June/01)
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