470 Johnson 2016 ElectionOfficeholder and Candidate
Campaign Statement -
Short Form Date of election if applicable:
(Month, Day, Year)
1. Statement Covers Calendar Year 20 1/6 -
RECEIVED _
M 470
❑ Amendment (Explain Below) AUG 12 2016 For Official Use only
CITY OF LA QUMITA
C ITY CLERK DEPARTMENT
2. Officeholder or Candidate Information 3. Office Sought or Held
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
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STREETADDRESS JURISDICTION (LOCATION) DISTRICT NUMBER
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CITY STATE ZIP CODE
AREA CODE/DAYTIME PHO ENUMBER OPTIONAL: FAX/E-MAILADDRESS
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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
S. 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 preparing this statement. I certify under penalty of perjury under the laws of the State of Calif is that t e fore ' is true and correct.
Executed on Jr
DATE1 RI ICERWER OR CANDIDATE
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FPPC Form 470/470 Supplement (Jan/2016)
FPPC Advice: advice@fppc.ca.go,• ' 61275-3772)
ppc.ca.gov