470 fficeho._~r and Candidate
Campaign Statement-
Short Form
(Government Code Section 84206)
Type or print in ink.
Date of election if applicable: [] Amendment (E~laln Below)
(Month, Day, Year)
SHORT FORM
For Olflc~ Use Only
CITY CUPERTINO
1. Statement Covers Calendar Year 20.~_~_.
2. Officeholder or Candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
STREET ADDRESS
AREA COD AY'nME PHONE NUMBER OPTIONAL: FAX / E-MAIL ADDRESS
3. Office Sought or Held
OFF,CE Sou=.,
JURISDICTION 1LOCATION) DISTRICT NUMBER
~ f 7-Y ~ ' f~ ~_.//~/~ ~-/,~1~:t (IFAPPLICABLE)
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. NUMeER 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 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
Executed o~California that the foregoing is true and correct.~, -- ~/~;~ -- ¢~.~.~OAT~ B~' ~~S~G..~?U RE~O~O~5~ATE
FPPC Form 450 (June/O1)
FPPC Toll-Free Helpline: 866/ASK-FPPC