470 Johnson 2018 ElectionOfficeholder and Candidate
Campaign Statement -
Short Form
1. Statement Covers Calendar Year 20
Date of election if applicable:
(Month, Day, Year)
Nov (, 2018
2. Officeholder or Candidate Information
NAME OF OFFICEHOLDER OR CANDIDATE
STREETADDRESS
CITY
AREA cCODE/DAYTIME PHONE NUMBER
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RECEIVEQ
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STATE ZIPCODE
C1- jZ2�'3
CITY OF LA QUINTA
CITY CLERK DEPARTMEF T
3. Office Sought or Held
OFFICE SOUGHT OR HELD
JURiSDICTI N (LOCATION) DISTRICT UMBER
OPTIONAL: FAX/E-MAILADDRESS
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 preparing this statement. I certify under penalty of perjury under the laws of the State of Calif ' that the foregoing is true and correct.
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Executed on �JL[ U�� /O ����
DATE OFFICEHOLDER OR CANDIDATE
Clear Form � Print Form
I FPPC Form 470/470 Supplement (Jan/2016)
FPPC Advice: advice@fppc.ca.gov'R66/275-3772)
Ippc.ca.gov