HomeMy WebLinkAboutMatthew Strzepek - Form 470 - 10-19-2012Officeholder and Candidate
Campaign Statement —
Short Form
(Government Code Section 84206)
Type or print in ink.
Date of election if applicable:
(Month, Day, Year)
/ / - & -/Z
1. Statement Covers Calendar Year 20 12- .
❑ Amendment (Explain Below) RECEIVE
2. Officeholder or Candidate Information 3.
NAME OF OFFICEHOLDER OR CANDIDATE
�a f�T Z�ye
STREET ADDRESS
2899 0
CITY STATE ZIP CODE
J / a.7 Cvil C% 93Vo/
AREA CODE /DAYTIME PHONE NUMBER OPTIONAL: FAX/
,FOSS— Z35--- �Z.J'/
OCT tl 2012
CITY
Office Sought or Held
OFFICE SOUGHT OR HELD
,J-4n Cv /t 061'J'p0 C,7 y U 1 Ci/
JURISDICTION (LOCATION)
(IFAPPLICABLE)
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 I COMMITTEE ADDRESS I 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 $1,000 and that I will spend less than $1,000 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 /D /f / Z By
DATE
SIGNATURE OF OFFICEHOLDER OR CANDIDATE
FPPC Form 4701470 Supplement (January/08)
FPPC Toll -Free Helpline: 8661ASK -FPPC (866/275 -3772)