HomeMy WebLinkAboutEmily Lo - Form 470Officeholder and Candidate
Campaign Statement -
Short Form
Date of election if applicable:
(Month, Day, Year)
1. Statement Covers Calendar Year 20
0 Amendment (Explain Below)
7�
CITY
Date Stamp
OF SA7i
CAFORMNIA 470
Eau. k3e
For Official Use Only
2. Officeholder or Candidate Information 3. Office Sought or Held
NAME OF OFFICEHOLDER OR CANDIDATE
STREET ADDRESS
&
Cil C(TY� 1J STATE ZIPCODE
EN/LY t -e9
� ���� OPTIONAL: FAX IE-MAIL ADDRESS
OFFICE SOUGHT OR HELD
JURISDICTION (LOCATION)
DISTRICT NUMBER
(IF APPLICABLE)
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 $2 ,000 and that I will spend less than $2,000 during the calendar year and that I have
used all reasonable diligence in preparin s this statement. I ertify under penalty of perjury under the laws of the State of Califomia that the foregoing is true and correct.
Executed on
Lclear Form
DATE
Print Form
By
SIGNATURE OF OFFICEHOLDER OR CANDIDATE
FPPC Form 470(470 Supplement (Jan/2016)
FPPC Advice: advice(gfppc.ca.gov (866/275.3772)
www.fppc.ca.gov