HomeMy WebLinkAboutBERNALD FORM 470Utticeholder and Candidate
Campaign Statement— Dale Stamp
Short Form RECEIVED
Date of election if applicable:
(Month, Day, Year) Amendment (Explain Below)
TY OF SARATO
1. Statement Covers Calendar Year 20 O
urncenolder or candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
M G f v- c k�
STREETADDRE S
I ,F39 F
CITY STATE ZIP CODE
AREA CODEIDAY I IME PH NUMBER OPTIONAL: FAX IE-MAIL ADDRESS
3. Office Sought or Held
JURISDICTION (LOCATION) DISTRICT NUMBER
(IF APPLICABLE)
` 6(3 aoG 154-- rm► bernaid /i6Dsar'cioga, ca us
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 candidacv.
COMMITTEE NAME AND I.D. NUMBER
N/A
5. Verification
COMMITTEE ADDRESS
NAME OF TREASURER
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 preparing this statement. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on (/ v 1 rj I
DATE
SIGNATURE OF OFFICEHDLD�I:AWIIIA�T���
FPPC Form 470/470 Supplement (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov