Form 470 08-17-22Officeholder and Candidate
Campaign Statement -
Short Form
1. Statement Covers Calendar Year 20
Date of election if applicable:
(Month, Day, Year)
1-1 Amendment (Explain Below)
Date Stamp
CITY CF ENCINITA
CITY CLERK
2022 AUG 17 PM 5: 1
For Official Use Only
2. Officeholder or Candidate Information 3. Office Sought or Held
NAM OF OFFICEHOLD OR CANDIDATE OFFICE SOy G�HT OR HELD
STREETADDRESS JURISDICTION (LOCATION) DISTRICT NUMBER
�� �� ��� n ���` f` �� (IFAPPLICABLE)
iVC� IVt �-s
AREA CODE/DAYTIME
OPTIONAL:
ZIP CODE
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
S. Verification
COMMITTEE ADDRESS
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 s
used all reasonable diligence in preparing this statement. I certify under penalty of perjury under the laws of the St3WTf Californ
Executed on <' / ! By
DATE
a
I Clear Foetn,
NAME OF TREASURER
than $2,000 during the calendar year and that I have
foregoing is true and correct.
OF OFFICEHOLDER OR CANDIDATE
FPPC Form 470/470 Supplement (Jan/2016
FPPC Advice: advice@fppc.ca.gov (866/275-37"2
www.fppc.ca lc��