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Candidate Intention Type or Print in Ink. CANDIDATE INTENTION <br /> <br /> Check One: I"I Initial [] Amendment [] Termination <br /> <br /> Office Use Only <br /> <br /> FULL NAME OF CANDIDATE (LAST, FIRST, MIDDLE) / <br /> <br /> ADD)lESS (NO.AND STRICT) DAYTIME PHONE <br /> <br /> CITY ' STATE ZIP CODE FAX U <br /> <br /> PUBL~GENC~NAME TYPE OF ELECTION <br /> JURISDICTI E SOUGHT (Check One)~ <br /> ~ State ~ Coun~ of <br /> D Multi-Coun~ ~City of ~ G~ ~~ <br />III Verification <br /> I ce~i~ under penal~ of perjury under the laws of the State of California that the foregoing is true and~orrect. <br /> Executedon ~' ~-- ~ ~ ~ -- <br /> OATE SI~NATUflE OF CA~DI~TE <br />FO~ ~O~E ~NFORMAT~ON REaU~ED TO BE P~OWDED TO YOU PURSUANT TO THE ~NFO~AT~O~ P~ACT~CES ACT OF ~ ~7, SEE ~NFORMAT~ON MANUAL A ON CAMPaigN D~SCLOSU~E <br />p~S~ONS OFTH~ ~OUT~CAL REFORM ACT. FPPC Form 501 (2/98) <br /> For T~chnical ~ssi~lafl~: ~lS1322-~SS0 <br /> <br />Campaign Bank Account Typ~ or Prin~ in ~nk. CAMPAIGN BANK ACCT. <br /> Check One: ~ Initi~ ~ Redesignate the Account for Future Election to the Same Office <br /> <br /> ~ Amendment ~ Termination (Not~: In addition, file a Form 501 it you ar~ no longer <br /> soliciting or receiving contributions.) Offic~ Us~ Only <br /> <br />I Candidate Information <br /> FULL NAME OF CANDIDATE (LAST, FIRST. MIDDLE) ' <br /> <br /> ADDRESS (NO. AND STREET) DAYTIME PHONE <br /> ( <br /> <br /> CITY STATE ~1~CODE FAX NUMBER ~E~ OF ELECTION <br /> ( ) <br /> OFF~CE SOUGHT ~ND ~ENCV N~E ~ ~PE OF ELECT~ON <br /> (C~.c~ O.. ~ ~.~c~) ~ Special ~ Rec~l <br /> I <br />II Account Information <br /> <br /> ADDRESS (NO. AND STREET) DAYTIME PHONE DATE OPENED (Mont~Oay/Year) <br /> <br /> ( ) <br /> CITY STATE ZIP CODE <br /> <br />III Verification <br /> I cerfi~ under penal~ of perjury under the laws of the State of California that the foregoing is true and correct. <br /> <br /> Executed on By <br /> DATE SIGNATURE OF CANDIDATE <br />FOR MORE INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INFORMATION MANUAL A ON CAMPAIGN DISCLOSURE <br /> pR~ISIONS OF THE POLITICAL REFORM ACT. FPPC Form 502 (2198) <br /> For Technical Assistance: 916/322-5660 <br /> h:~campaign~lorm s~501-502'98 <br /> <br /> <br />