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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) City Clerk's 1. Statement Covers Calendar Year 20 _lli_ . 2. Officeholder or Candidate Information STREET ADDRESS CITY STATE ZIP CODE q~SDl AREA CODE/DAYTIME PHONE NUMBER flD '::f~(g--jfq~ 4. Committee Information 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. COMMITIEE NAME AND 1.D. NUMBER COMMITIEE ADDRESS NAME OF TREASURER 5. Verification ! 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 foregoing is true and correct. Executed on ___ ~~/~l _aJ ____ c..-_o_v_) __________ _ DATE FPPC Form 450 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC