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CAMPAIGN BANK AC( <br /> <br /> Campaign Bank Account Type or Print in Ink <br /> C,~,;ck One: 1~ Initiat [] Amendment [] Termination <br /> Office Use Only <br /> <br /> I Cand!d__te Infoi~iiiation <br /> FULL NAME OF CANDIDATE: (LAST, Fi~¥, MIDDLE) <br /> <br /> ADDRESS (NO, AND STREET) <br /> <br /> STATE ZIP CODE <br /> <br /> SPECIFIC OFFICE SOUGHT: <br /> <br /> II Account Information <br />- FINA~IAL INSTI~TION: <br /> ~ ~ ~ AREA ODD.HONE NUMBER <br /> ADDRESS (NO AND STREET) <br /> <br /> STATE ZiP CODE <br /> <br /> I ce.ify under penalty of perjury under the laws of the State of California that the foregoing is tree ~d c9~ect. / <br /> <br /> Candidate Intentionmype <br /> ' Office Use Onl~ <br /> I Candidate Info.nation <br /> FULL NAME OF CANDIDATE: (~ST, ~i~T, MID~E) <br /> <br />  AR~COD~A~IME PHONE <br /> ADDRESS: (NO. ANDSTREET) ~, /~ (~,~ <br /> <br /> PUBLIC AGENCY NAMe: <br /> <br /> OURISDIOTION AND LOCATION: <br /> <br /> ~ Multi-Oounty Jurisdiction: <br /> <br /> Ill Ce~ification <br /> I certify under penalty of perjury under the laws of the State of California that the foregoing is <br /> <br /> xecuted on i ~ ~ At~O ~CtTY, ~ By <br /> ~ 7 *TF /~G~ATURE OF CANDIDAT~ <br /> <br /> <br />