Elefant 460,;Officeholder and Candidate
Campaign Statement -
Short Form
(Government Code Section 84206)
Type or print In Ink.
Date of election If applicable: D Amendment (Explain Below)
(Month, Day, Year)
JUL 1 6 2001
--------C ty Clerk's Offi
1. Statement Covers Calendar Year 20 Qi__ .
2. Officeholder or Candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
Ann.g_ L. e.-c~~M:
STREET ADDRESS
CITY
CIA
ZIP CODE
C/<.('::>LfJ--
3. Office Sought or Held
OFFICE SOUGHT OR HELD
AlJ5
DISTRICT NUMBER
(IF APPLICABLE)
Ai4~k
AREA cooiaAYrlME PHONE NUMBER OPTIONAL: FAX I E-MAIL ADDRESS
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 l.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
California that the foregoing is true and correct.
Executedon ____ ':f .. /_5_,/..._D_I ----------
DATE
By __ '""""" ,:;.;;}.....,_,.~£=-· ____ _ SIGNATUREOFO~ORcANDIDATE
Fonn 470/470 Supplement(12/99)
For Technical Assistance: 916/322-5660
State of California