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Check On,: r-I in,t,a, [-I Rede,,gn,te the Account ,or Future Elect,on to the Same Ofhce CALIFORNIA 502 <br /> [] Amendment ~Termination (Note: in addition, file a Form 501 if you are no longer 1995/96 FORM <br /> sohcltmg or receiving contributions.) <br /> i Office Use Only <br />i Candidate Information <br /> FULL NAME Of: CAIdO40~TE (LAST. FIRST, MIDOLE) <br /> <br /> ~F~ S~ ~O A~KY ~Mt / <br /> <br />II Account Information ~ .. <br /> <br /> 4~ ~~ d~ ACCENT .UMBEl <br /> <br /> ADD~SS~D / ~~~O A~ STeEl) ~wv~~ff~&~ (~/~ll~l C~E~HONE3~ ~--/~NUMBERDATE <br /> <br /> STATE ZIP C~E <br /> <br />III Verifi~tion <br /> I ce~ity under ~nalty of ~qury under the laws of the State of California that the foregoing ,s true and torreS. <br /> <br /> Date CITY A~ s~te ~ SIGNATURE 0f CANDID~' -- <br />[~ IN[OalllON ~QUI~O I0 [ P~VI[O I0 YOU PURSUAN110 IH[ INfO~TIO~ ~1C[$ ACT ~ 1~!?. ~[[ I~[~AIION ~A~URL <br /> ~III(AL ~f~ A~. N ~ <br /> Sate el bl~anii Fair P~I Pri~s ~mis~. <br /> <br /> <br />