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Gampaiyn rsan NVGOU� Retlesi9na�etheA YP�-------- _ -- ___ <br /> Check One: f�Ini�ial ❑ ccoun�br Future Elec�ion to�he Same Oflice • ' ' p , <br /> • - <br /> ❑ Amendment ❑ Terminalion(NOte: In addition,tile a Form 501 if you are no lonyer <br /> solicitinq or receiving conUibuGons.) Ouice use Only <br /> I Candidate Information <br /> FULL MIEOFGM/DIMTE (LABT IRBT.YIDDLE� � �� j . <br /> �� �;c� �h ��-bc��� � <br /> ADDRE55 (NO.AND STREET) DAYTIME PHONE <br /> �� STATE ZIP CODE VEAP OF ELECTION <br /> � � ( ) — <br /> OFFI E SOUGHT AND AGENGY N�YE TVPE OF EIECTON � SOBCIBI ❑ RBCBII <br /> � _ (C�ock One 11 Appliuble� <br /> Cl .VL C- <br /> II Accou t Information <br /> flNANCI�L INSTITUTION ACCOUNT NUYBER <br /> ADDFE55 (NO.ANO S7HEE � DAYTIME PHONE DATE OPENED(NOntNO�Y/Y�vj� <br /> .� vc ` � n <br /> � gj E ZIP CODE Q/ <br /> l e� ` <br /> III Verification • <br /> I certiy untler penalry ot perjury untl r the laws of the State of California that the for mg is tru/e antl correct. � <br /> /���'q By�� /�> > Cn' -d�7 l.� C.Q.-�—�—�� <br /> Execu�edon ���� SIGNATUH� F DIONTE <br /> FOHMOREWFORMATIONREOUIREDTOBEPRWIDEOTOVOUPURSl1FNTTOTMEINFOPMATIONPRACTICESNCTOFI9]),SEE�YFJfl �On .AM1:vaGnOlc_ . O�iwF <br /> , a r�p���r FPPC Form 502 (2/98) <br /> ForTechnical Assislance: 916/322•5660 <br /> h:\camDOipn\Iorm�l50 Fb02'GB <br /> v�v�sv ' <br /> J <br /> Return Address of Filer I I ( II P�� <br /> First Class <br /> Postaga <br /> Here <br /> <; f d �� �1 � � <br /> c ; � i <br /> Secretary of State <br /> Political Reform Division <br /> 1500 11 th Street <br /> P.O. Box 1467 <br /> Sacramento, CA 95812-1467 <br /> ILL,�LI,L�L���IL,LI���IIJ��LII�J„�LII„L.dJ��ll <br />