Kennedy 470Officeholder and Candidate
Campaign Statement -
Short Form
(Government Code Section 84206)
Type or print in ink.
Date of election if applicable: O Amendment (Explain
(Month, Day, Year)
1. Statement Covers Calendar Year 20 b +-.
OF ALAMEDA
CLERK'S OFFICE
2. Officeholder or Candidate Information
NAME OF OFFICEHOLD!'R 0 CfNDIDATE I
3. Office Sought or Held
OFFICE SOUGHT OR HELD
tU \.(/\ ~l/\-exY
STREET A DRESS
ZIP CODE
Cfi ctvrot
OPTIONAL: FAX/E-MAILADDRESS
DISTRICT NUMBER
(IF APPLICABLE)
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 foregoipg is ue and correct. ·
71Jt ()r Exec~edon~~~_..;.~~-'-~~~~~~~~~~~~
CANDIDATE
FPPC Form 450 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
Officeholder and Candidate
Campaign Statement
Form 470 Supplement
(Government Code Section 84206)
SEE INSTRUCTIONS ON REVERSE
Type or print in Ink.
D Amendment (Explain Below)
This form is written notification that the officeholder/candidate listed below has received contributions totaling
$1,000 or more or has made expenditures of $1,000 or more during the calendar year.
1. Officeholder or Candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
STREET ADDRESS
CITY
AREACODE/DAYTIMEPHONENUMBER
2. Office Sought
OFFICE SOUGHT
DATE OF ELECTION {MONTH, DAY, YEAR)
STATE ZIP CODE
OPTIONAL: FAX I E-MAIL ADDRESS
DISTRICT NUMBER
(IF APPLICABLE)
FORM 470 SUPPLEMENT
Date Stamp
CALIFORNIA 470
FORM SUPPLEMENT
For Official Use Only
3. Date Contributions Totaling $1,000 or More Were Received or Date Expenditures of $1,000 or More Were Made
(MONTH, DAY, YEAR)
FPPC Form 450 (June/01)
FPPC Toll-Free Helpline: 866/ASK·FPPC