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Kevin R. Kearney 470Officeholder and Candidate Campaign Statement - Short Form Type or print in Ink. (Government Code Section 84206) Date of election if applicable: (Month, Day, Year) 1. Statement Covers Calendar Year 20 l> S . 2. Officeholder or Candidate Information STREET ADDRESS / /! AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX I E-MAIL ADDRESS :::/o-?b7 ?52-[l 4. Committee Information 3. Office Sought or Held OFFICE SOUGHT OR HELO CtT'-' JURISDICTION (LOCATION) L J T'-tJ..f:: ALA~ 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 $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 s of the State of California that the foregoing is true and correct. Executedon--~-4'?Z--; .............. -+--oA-~ 2=--JJ_-=-2=CD _____ _...,,_1j_ 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 AREA CODE/DAYTIME PHONE NUMBER 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