HomeMy WebLinkAboutForm 470 - Maribeth Bushey 2022Officeholder and Candidate
Campaign Statement —
Short Form
Date of election if applicable:
(Month, Day, Year)
11/08/2022
1. Statement Covers Calendar Year 20 22
11 Amendment (Explain Below)
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AUG - 1 2022 11 A
2. Officeholder or Candidate Information 3. Office Sought or Held
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
Maribeth Bushey
STREETADDRESS
CITY STATE ZIP CODE
San Rafael CA 94901
AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX/ E-MAILADDRESS
CLERK'S OFFICE
San Rafael City Councilmember
JURISDICTION
City of San Rafael
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
5. Verification
COMMITTEE ADDRESS
For Official Use
(IF APPLICABLE)
3
NAME OF TREASURER
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
DATE
FPPC Form 470/470 Supplement (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppe.ca.gov