Kennedy 470Officeholder 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)
1. Statement Covers Calendar Year 20 ___ _
2. Officeholder or Candidate Information
AREA CODE/DAYTIME PHONE NUMBER
4. Committee Information
STATE ZIP CODE
OPTIONAL: FAX I E-MAIL ADDRESS
3. Office Sought or Held
OFFICE SOUGHT OR HELD
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 receiye 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.1~.<1ertify under penalty of perjury under the laws of the State of
California that the foregoing is true and correct. ~~/
Executed
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.
0 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
STREET ADDRESS
CllY
AREA CODE/DAYTIME PHONE NUMBER
2. Office Sought
OFFICE SOUGHT
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