Kearney 470Officeholder and Candidate
Campaign Statement —
Short Form
(Government Code Section 84206)
1. Statement Covers Calendar Year 20
Type or print in ink. Date Stamp
Date of election if applicable:
(Month, Day, Year)
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0 Amendment (Explain Below)
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SHORT FORM
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40000000606,„„„
For Official Use Only
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2. Officeholder or Candidate Information
NAM OF OFFICEILDER OR CAN IDATE
X / 1
STR ET A DREbS i
STATE ZIP CODE
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AREA CODE/DAYTIME PHO 'NUMBER OF/ NAL: FAX/E-M AJL ADDRESS
3. Office Sought or Held
OFFICE SOU HT OR HELD
JURISDICTI
DISTRICT NUMBER
(IF APPLICABLE)
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 I.D. NUMBER COMMITTEE ADDRESS NAME OF TREASURER
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5. Verification
I declare under penalty of perjury that to the best o
calendar year and that I have used all reasonable iligence in preparing this statement. I certify under pena of perjury under the laws
that the foregoing is true and correct.
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DATE
my knowledge I anticipate that I will receive less than $1,000 and that I will spend less than $1,000 during the
the State of California
Executed on
By
OF OFFICEHOLDER OR CANDIDATE
FPPC Form 470/470 Supplement (January/08)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661276-3772)