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Candidate Intention Ty~ or Print in Ink. CANDIDATE INTENTION <br /> Check One: [] ~r~M I-I AmenckT~nt <br /> <br />II Office Sought <br /> <br /> ITYPe O~ EJ. EDTION <br /> PUBLIC AGENCY NAME IlCh~ll O~e ~ Am~l,ca=~e) [] Special F'l Rec~ll <br /> <br /> JURISDICTION OF ELECTIVE OFFICE ~,OUGHT <br /> r'~ State [] County of <br /> [] Multi-County [] Cityof <br /> <br />III Verification <br /> I cert~h/un(~er oenalty ct ~enury uncler tt~e Jaws of the State of Califorma treat We foregoing is true anct correct. <br /> <br /> SlG,ATU,E OF CANDI~.~E -- <br />FOR MORE IN;ORMA'r~oN REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACTOF 197'1. SEE INI=QRMATION MANUAL A ON CAMR&]GN DISCLOSURE <br />PROV)S)ONS O~= 'Hr_ ~CL~C.~L ~EFOR'.~ ACT FPPC Form 501 (1997) <br /> For TcchnJcll Aseistance: ~16/322-5660 <br /> <br />Campaign Ban k Account T~p, or Print in )nit CAMPAIGN BANK ACCT. <br /> <br /> Check One: [] Inmal [] Recles~gnate rne Account for Future Election to We Same Office <br /> <br /> [] AmenDment [] Termmat~on (Note: in aUclJ)on, file a Form 501 Jf you arm no longer <br /> solic~ng or recelwng contni~ut~ons.) Off*c. use On~ <br /> <br />I Candidate Information <br /> FULL NAME OF CANDIDATE (LAST, FIRST. <br /> <br /> ~C. DFqE$$ '~0 ANO $TREETi DAYTIME PHONE <br /> <br /> ) <br />3:T¥ STATE ZiP CODE FAX NUMBER YEAR OF ELECTION <br /> ( <br />OFFICE SOUGHT AND AGENCY NAME I TYPE OF ELECTION <br /> I <br />II Account Information <br />FINANCIAL INSTI~ON I ~CO~ NUMBER <br /> I <br /> *OO~E S5 , NO AND STREET) DAYTIME PHONE <br /> I <br /> ( <br /> <br />III <br /> I cem~ un,er pe~ of pequ~ un,er <br /> <br /> ~ on By <br /> <br />FOR ~RE iNFORMATION REQUIRED ~ BE P~ <br />PR~S~ONS oF ~; .~u~c~ REFORM ~, FPPC Form 502 (~9~ <br /> For Technical Alliltlngl: g16~-S660 <br /> <br /> <br />