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(408)867-5677
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NAME OF ASSISTANT TREASURER, IF ANY
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Attach additional information on appropriately labeled continuation sheets.
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Candidate Intention Statement
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Check One:
1. Candidate Information:
FAX NUMBER (optional)
DAYTIME TELEPHONE NUMBER
(Last, First, Middle Initial)
DISTRICT NUMBER, if applicable.
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❑ State (Complete Part 2.)
(Name of Multi -County Jurisdiction)
❑ Multi -County:
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(Ca1PERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
Special/runoff election
(Year of Election)
Primary/general election
-9
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(Check one box)
❑ I accept the voluntary expenditure ceiling for the election stated above.
❑ I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
(Mark if applicable)
, I contributed personal funds in excess of the expenditure ceiling for the election stated above.
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