470 Sylk 2022 ElectionOfficeholder and Candidate
Campaign Statement —
Short Form
1. Statement Covers Calendar Year 20 1-2'
Date of election if applicable: I ❑ Amendment (Explain Below)
(Month, Day, Year)
Date Stamp
RECEIVED
SEP 2 8 2
/1/,fy 9y llL l I CITY OF LA QUINTA
CITY CLERK DEPARTME
2. Officeholder or Candidate Information 3. Office Sought or Held
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
STREETADDRESS JURISDIC710N (LOCATION) DISTRICT NUMBER
r`1 , 1/1 — (IF APPLICABLE)
-7s
-7806
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
Use On
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 California that the foregoing is true and correct.
Executed on � � � � � �Z By sitk�ru+2 F
DATE
CANDIDATE
FPPC Form 4701470 Supplement (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (8661275-3772)
wv )c.ca.gov