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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 m 1 c \--\-ertL Vb cm IJ \;~or\l STREET ADDRESS ' ZIP CODE ti '{')O \ JAN 3 1 2005 CITY CLERK'S OFFICE 3. Office Sought or Held OFFICE SOUGHT OR HELD JURISDICTION (LOCATION) vtu~ ~"91+ oL Bo fr{20 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) FPPC Toll-Free Helpline: 866/ASK-FPPC