470 Debt Retirement Annual
Type or print In Ink.
. Officeholder and Candidate
Campaign Statement -
Short Form
(Government Code Section 84206)
JAN 3 2005
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CUPERTINO CITY CLERK
o Amendment
Date of election If applicable:
(Montll, Day, Year)
(Explain Below)
nla
Office Sought or Held
OFFICE SOUGHT OR HELD
3.
Year 20-ºL
nformation
Covers Calendar
Officeholder or Candidate
NAME OF OFFICEHOlDErt OR CANDIDATE
Statement
1
2.
DISTRICT NUMBER
(IF APPLICABLE)
Councilmember
JURISDICTION (LOCATION)
City of Cupertino
ova
10720 Alderbrook Lane
CITY-
ZIP COOE
STATE
Cupertino, CA 95014
AREA CODElDAYTIME PHONE NUMBER
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FPPC Form 470 (June/01)
FPPC TolI.Fr.. Helpline: 866/ASK.FPPC
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make expenditures on behaif of your candidacy.
I NAME OF TREASURER
Verification
I declare under penalty of pe~ury 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 prepartng this statement. J C~rti un. der penalty Of~' nder the laws of the State of
California that the foregoing Is true and correct. : 0
' ,
January 2~2005 ~ ¡;:;' ~. j
DATE
SIGNATURE OF OFFICEHOLDER OR CANDIDATE
Dolores Sandoval
I
ADDRESS
Committee Information
List all committees of which you have knowiedge that are primarily formed to receive contributions or to
COMMITTEE NAME AND 1.0. NUMBER COMMITTEE ADDRESS
Dolly Sandoval for Supervisor 10720 Alderbrook Lane
Debt Retirement Committee Cupertino, CA 95014
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Executed on_
By
FAX I E-MAIL
OPTIONAL;
4.
5.