HomeMy WebLinkAboutHEAP 501 andidate Intention Statement
Type or Print in Ink.
Date Stamp
CANDIDATE INTENTION
Check One: ~ Initial
[] Amendment
99DEC 15 P~I I: 13
[~AKER~- =LD CJl ¥
1. Candidate Information
FULL NAME OF CANDIDATE (LAST, FIRST, MIDDLE)
ADDRESS (NO, AND STREET) DAYTIME PHONE
CITY STATE ZIP COOE FAX E-MAIL (OPTIONAL)
2, Office Sought
OFFICE SOUGHT (POSITION TITLE)
PU~L;C AGENCY NAME
DISTRICT NUMBER
[] NON-PARTISAN Y;R==IO N
pARTy:
TYPE OF ELECTION (Check One if Applicable)
~.ISDICTION OF E~CTIVE O~E~E SOU~ (O~
[] ST^TE [] COU"W O~
3. Verification
I cedify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
DATE SIGNATURE OF CANDIDATE
FPPC Form $0! (8/99)
For Technical Assistance: 916/322-5660