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470 Annual 2005 28 JUL (Explain Bel Type or print in ink. D Amendment Date of election if applicable: (Month, Day, Year) Officeholder and Candidate Campaign Statement - Short Form (Government Code Section 84206) ERTlNG CITY CLEF!lK 3. Office Sought or Held OFFICE SOUGHT OR HELD 04 Officeholder or Candidate Information NAME OF OFFICEHOLDER OR CANDIDATE Year 20 Covers Calendar Statement 1 2. Councilmember JURISDICTION (LOCATION) City of Cupertino Dolores Sandoval STREET ADDRESS DISTRICT NUMBER (IF APPLICABLE) STATE ZIP CODE CA 95014 OPTIONAL: FAX/E·MAILADDRESS 10720 Alderbrook Lane CITY Cupertino AREA COOEIDAYTIME PHONE NUMBER 408/725-8939 of your candidacy NAME OF TREASURER /mow/edge that are primarily formed to receive conlributions or to make expenditures on behalf NUMBER COMMITTEE ADDRESS Committee Information List all committees of which you have COMMITTEE NAME AND 1.0. - 5. Verification 4. I declare under penalty of pe~urythat to the best of my knowledge I anticipate that I will FPPC Form 470/470 Supplement (January/05) FPPC Toll-Free Helpline: 866/ASKMFPPC (8661275-3772) By Executed on