Anna Elefant 470Officeholder and Candidate
Campaign Statement -
Short Form
(Government Code Section 84206)
Type or print in ink.
i'
Date of election if applicable: D Amendment (Explain~)
(Month, Day, Year)
SHORT FORM
CALIFORNIA 470 FORM
For Official Use Only
_____ C_i__,,ty Clerk's Offic,_)
1. Statement Covers Calendar Year 20 _QJ_ .
2. Officeholder or Candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
A /\NA
STREET ADDRESS
STATE ZIP CODE
AREA CODEJDAYTIME PHONE NUMBER
LA 1l(JD 0
§'tu-§ ~-l -?>5D~
4. Committee Information
3. Office Sought or Held
OFFICE SOUGHT OR HELD
JURISDICTION (LOCATION) 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 l.D. NUMBER COMMITIEE 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 foregoing is true and correct.
Executed on ____ I +-/ _1 ~[ +\ _O_\ _L..._ ____________ _
DATE
FPPC Form 450 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC