HomeMy WebLinkAboutForm 470- Maika Llorens Gulati 2015Officeholder and Candidate a • - '
Campaign Statement - • -III
Short Form Date of election if applicable: SEP 2 5 1015 For Official Use Only
(Month, Day, Year) Amendment (ExpIaID Below)
Time:
11, 03, 2015 City ClerWs Office
City of San Rafael
1. Statement Covers Calendar Year 20 15
2. Officeholder or Candidate Information 3. Office Sought or Held
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
Maika Llorens Gulati School Board Member
STREETADDRESS JURISDICTION (LOCATION) DISTRICT NUMBER
(IF APPLICABLE)
San Rafael City Schools
CITY STATE ZIP CODE
San Rafael CA 94901
AREA CODEIDAYTIME PHONE NUMBER OPTIONAL FAX I 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 $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.
Digitally signed by Maika Llorens Gulati
ON. cn=Maika Llorens Gulati, o=HeadsUp, ou,
email=maika@headsupsr.org, c=Uti
Executed on October 24, 2015 By Dates 2015.09.24 08.46.41 -Joo
DAT'. SIGNATURE OF OFFICEHOLDER OR CANDIDATE
FPPC Form 470/470 Supplement (Jan/2008)
FPPC Form 470/470 Supplement Instructions - Rev. 2 (Dec/2012)
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