HomeMy WebLinkAboutHEAP 502 ampaign Bank Account
Type or Print in Ink.
Dale Stan~
CAMPAIGN BANK ACCOUNT
Check One: J~nitial
[] Amendment
1. Candidate Information
FULL NAME OF CANDIOATE (LAST, 'FIRST, MIDDLE)
ADORESS (NO. AND STREET)
CITY
[] Redesignate the Account for Future
Election to the Same Office
STATE ZIP CODE
0O
For Official Use O~y
OFFICE SOUGHT AND AGENCY NAME
~ccount Information
DAYTIME PHONE
FAXNUMBER
( )
E-MAIL (OPTIONAL)
OF
ELECTION
DAYTIME
CrTY
3. Verification
IACCOUNTNUMBER
DATE OPENED (Monlh/Oay/Year)
I certify under penalty of perjury under the laws of the State of California that lhe foregoing is tree and correct.
DATE
FPPC Form 502 (8/99)
For Technical Assistance: 916/322-5660