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CA Form 470 Officeholder and Candidate Campaign Statement - Brian Campbell Officeholder and Candidate RE'al V 6 CALIFORNIA 470 Campaign Statement - CITY OF RANCHO PALO' rORM Short Form Date of election if applicable: ❑ Amendment (Explain Below) For Official Use Only (Month,Day,Year) 1 JUL 3 1 2011 11/5/2013 CITY CLERK'S FILE 1. Statement Covers Calendar Year 20 17 . 2. Officeholder or Candidate Information 3. Office Sought or Held NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD Brian Campbell Mayor STREET ADDRESS JURISDICTION(LOCATION) DISTRICT NUMBER (IF APPLICABLE) Rancho Palos Verdes CITY STATE ZIP CODE Redondo Beach CA 90277 AREA CODEIDAYTIME PHONE NUMBER OPTIONAL: FAX/E-MAIL ADDRESS 424 237-2582 Campbell.rpv@gmail..com 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 . 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 California that the foregoing is true and correct. Executed on (�� �i ,L By - DATE CiealrForm ri titit�`Form f FPPC Form 470/470 Supplement(Jan/2016) FPPC Advice: advice®fppc.ca.gov(866/275-3772) www.fppc.ca.gov " Officeholder and Candidate Date Stamp CALIFORNIA 470 Amendment (Explain Below) Campaign Statement - FORM Form 470 Supplement For Official Use Only SEE INSTRUCTIONS ON REVERSE This form is written notification that the officeholder/candidate listed below has received contributions totaling$2,000 or more or has made expenditures of$2,000 or more during the calendar year. 1. Officeholder or Candidate Information NAME OF OFFICEHOLDER OR CANDIDATE N/A STREET ADDRESS CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX/E-MAIL ADDRESS 2. Office Sought OFFICE SOUGHT DISTRICT NUMBER (IF APPLICABLE) N/A DATE OF ELECTION(MONTH,DAY,YEAR) 3. Date Contributions Totaling$2,000 or More Were Received or Date Expenditures of$2,000 or More Were Made N Ft (MONTH,bbbAY,YEAR) ,Acrev. "Fri; FPPC Form 470/470 Supplement(Jan/2016) FPPC Advice: advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov