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470 Annual Type or print in ink. D Amendment (Explain Below) Date of election if applicable: (Month, Day, Year) Officeholder and Candidate Campaign Statement Short Form (Government Code Section 84206) PERTINO CITY CUERK Officeholder or Candidate Information NAME OF OFFICEHOLDER OR CANDIDATE Dolores Sandoval STREET ADDRESS 10720 Alderbrook Lane CITY Cupertino AREACODEJDAYTIME PHONE NUMBER DISTRICT NUMBER (IF APPLICABLE) Held or OFFICE SOUGHT OR HELD Councilmember JURISDICTION (LOCATION) City of Cupertino Office Sought 3 05 Covers Calendar Year 20 Statement 1 2 STATE ZIP CODE CA 95014 OPTIONAL: FAX I E-MAil ADDRESS 408/725-8939 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 1.0. NUMBER COMMITTEE ADDRESS NAME OF TREASURER 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 of the State of California that the foregoing is true and correct. 5. July 30, 2005 DATE SIGNATURE OF OFFICEHOLDER OR CANDIDATE FPPC Form 470/470 Supplement (January/OS) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) By Executed on