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Check One: [-] Initial I-I Amendment ~1~ Termination <br /> I Candidate Information office use Only <br /> <br /> FULL MAMF OF CAMDIOATE (.~, FIRST. MIDOI~) <br /> <br /> ADDRESS ~O. AND 5T~E~ ~REA CODE/DAYTIME PHONE <br /> <br /> ~ice Sought <br /> <br /> PUBLIC AGENCY NAME ~PE ~ ELE~OM <br /> (C~ifA~ica~e) ~ Special ~ Recall <br /> <br /> JUm~I~ION OF ELE~IVE OFFICE SOUGHT (C~ O~) <br /> <br /> ~ State ~ Coun~ of <br /> <br /> [] Multi-County [] City of <br /> <br /> II! Verification <br /> I certify under penalty of R~rjury under the lows of the State of California that the foregoing is true <br /> <br /> Exec~ on At By SIGNATURE <br /> I ~TE CITY AND STATE f ~ ~ ' ' OF CANDIDATE <br /> <br /> FOR INFO~ATION REQUI~D TO BE ~VI~D TO YOU PURSUANT TO THE ~FORMATION ~ICES A~ OF 1977. ~E INFO~ATI~ MANUAL A ON ~MPAIGN DI~LOSU~ ~OVISIONS OF THE <br />.~ POLITI~L ~F~ A~. <br />  S~te of ~l~ornia Fai~ ~iai ~a~ C~miss~. <br /> <br /> Campaign Ban k Account Type or Print in Ink. CAMPAIGN BANK ACCT. <br /> <br /> Check One: [] Initial [] Redesignatethe Account for Future Election to the Same Office <br /> [] Amendment ~ Termination (Note: In addition, file a Form 501 if you are no longer <br /> soliciting or Eeceiving contributions.) <br /> Office Use Only <br /> <br /> . I Candidate Information <br /> .. CANmOATE (~.AST. r. msT..~OU.E) <br /> <br /> · II Account Information <br /> FIMAMOAL IMSl111JTIOM <br /> <br /> ADDRESS (NO. AND STREET) AREA COC~c/I~ONE NUMBER <br /> I <br /> <br /> _ I ce~i~ under penal~ of ~rju~ under ~e la~ of ~e State of California tbt ~e ~oing is <br /> <br /> L DA~ ~ A~ ~ATE <br /> <br /> FOR INI:ORMATION REQUIRED TO B~ PROVIDED TO YOU PURSUANT TO THE IM:ORMATION PRACTICES ACT Of 1977, S~E INF01~4ATION MANUAL A ON CAMPAI~iN DISCLOSURE I~VISIONS OF THE <br /> <br /> <br />