Kearney 460Officeholder and Candidate
Campaign Statement -
Short Form
Type or print in ink. Date Stamp
JUL 1 1 2001
(Government Code Section 84206) Date of election if applicable: D Amendment (Explain Below)
(Month, Day, Year)
--------"r.C ty Clerk's Offi
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1. Statement Covers Calendar Year 20(2 l
2. Officeholder or Candidate Information 3. Office Sought or Held
"!AME OF OFFICEHOLDER OR CANDIDATE )~E'J4f1-vE:v/_ OFFICE SOUGHT OR HELD
J'\t-) J µ rt Au i ft>(/_
STREET ADDRESS
c 6+ (IF APPLICABLE)
STATE ZIP CODE
14 ~Al1-pe1)x4 c.4 £'t)5"t5J
AR~DbA~7Z~~B~;{ £~ 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 1.0. 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 spe ess than $1,000 during
the calendar year and that I have used all reasonable diligence in preparing this statement. I certify un er penalJY of perjury u the laws of the State of
California that the fo going is true and c rrect. ~
)~ , Executed on BY-=--------.,.::;;:::;__ _________ -\------
SIGNATURE OF OFFICEHOLDER OR CANDIDATE
Fonn 470/470 Supplement(12/99)
For Technlcal Assistance: 916/322-5660
State of California