470 Campaign Statement 2012 Officeholder and Candidate SHORT FORM
Cam al �l Stat@CTl@Ilt— Type or print in ink. � . , I
Short Form � � � u U � • - '
(Government Code Section 84206) Date of election if applicable: � Alll@I1dRl@Ilt (Explain Below) For Official Use Only
(Month,Day,Year)
DEC - 5 ?,;2
P
1. Statement Covers Calendar Year 20 13 ,
2. Officeholder or Candidate Information 3. Office Sought or Held
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
Rod Sinks City Council
STREET ADDRESS JURISDICTION(LOCATION) DISTRICT NUMBER
(IF APPLICABLE)
Cu ertino
CITY STATE ZIP CODE
CA 95014
AREACODE/DAYTIMEPHONENUMBER OPTIONAL: FAX/E-MAILADDRESS
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
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 enalty erju under the laws of the State of California
that the foregoing is true and correct.
Executed on 12/4/2012 BY
DATE SIGNATURE OF OFFICEHOLDER OR CANDIDATE
FPPC Form 470/470 Supplement (January/08)
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