HomeMy WebLinkAboutPALMER 501 andidate Intention Statement Typo or Print in Ink. Da,e S~amp CANDIDATE INTENTION
Check One: /~lnitial
1. Candidate Information
FULL NAME OF CANDIDATE (LAST, FIRST, MIDDLE)
[] Amendment
For Official Use O~ly
ADDRESS (NO. AND STREET)
STATE
ZIP COOE
DAYTIME PHONE
2. Office Sought
OFFICE SOUGHT (POSITION TITLE)
PL~LIC AGENCY NAME
DISTRICT N~ M ~'." ,~
JURISDICTION OF ELECTIVE OFFICE SOUGHT (Chec~ O~e)
FAX
E-MAIL (OPTIONAL)
I i'NON-PARTISAN I YEAR OF ELECTION
TYPE OF ELECTION (Check One fl Applicable)
[] Special [] Recalr
[~] STATE
F1MULTI-COUNTY
3. Verification
I certify under penalty of perjury under the laws of the State of California that lhe foregoing is true and correct.
FPPC Form 501 (8~99)
For Technical Assistance: 916/322-5660