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FEB -28-1997 1125 <br />SLOCKTON PERMIT CENTER <br />rM, <br />&P-cJp' IH c, <br />(type and <br />on oath declare that: <br />(Please check appropriate statement <br />Owner Applicant <br />M <br />1 have Dal made an <br />to any member of <br />I have made a cam <br />$—jf�)— to <br />months. <br />owner for a <br />applicant for a <br />complete) <br />2 9+937+8893 <br />M <br />mpaign contributions in the amount of $250 or more <br />Planning Commission within the past 12 months. <br />contribution for (local) (State) (federal) election of <br />within the last 12 <br />(name of Commissioners <br />I understand that Go lernment Code Section 84308 requires this disclosure <br />and l make this disclosure in compliance therewith. Further, I he'rebydeclare <br />that 1 shall not make any campaign contributions of $250 or more to any <br />member of the Plan iing Commission while my application is pending or <br />within 3 months after a decision thereon by the Planning Commission. <br />1 am informed and be�lieve that to do so would be a violation of State law. <br />I declare under penalty of perjury that t e foregoing is t e and corrgct. <br />Executed in Stockton, California, this 3- day of��997. <br />rrppacant <br />TOTAL P.03 <br />