Case 8:10-cv-01573-AG -PLA Document 24-4 Filed 01/09/11 Page 1 of 1 Page ID

FOR OFFICE USE ONLY

#:504 FOR OFFICE USE ONLY

501 lssued: Yes ! ! Date: _

No coNrEsrrD# /]O {
50t Filed Yes n E Date: _
No cANDIDATEID# -/--
470 lssued: Yes i No tr Date _ DATE INFORMATION _4fxwnl.rr
470 filed: Yes ! No O Dare. _
CFCP Issued:Yes ! No C Date: _ STATEMENT LTR OF AUTHORZATION
CFCP Filed: Yes ! No I Dare: _ _oRrcrNAL
-AGENT DOC Cn€N

NAME OF CANDIDATE Cqettt E- Lrr'.'co-r<

(Plece print name 6 registered)
-
PHONETIC PRONI'NCIATION OF NAME:

RESIDENcEADDRESS: g'L9 Ftz{<h,crf Auz Qo,o-"o P^-'*Ds^sA 1(e 34

MAILING ADDRESS:
TELEPHONE o, 5cZ -1h% -'Z-Sao
(days) (evenings) (cell)

E-MAIL: 1$ecf*s. l,',,..

FILINGFOROFFICEOF {/-S . SEN"I+TZ OF THE

Cz-zz Fap"xsta DISTRICTFoRTHE D€ztuocd+Tl.K.- zARTyNoMINATToN.

n runrERMpostrioN I sgoRrrsRMposrrroN
AREYOUANINCUMBENT? NYES E} NO IFYES,YOUARE. N ELNCTEO [] EPPOTXTPO

SANDTDATENAMEToAppEARoNTHEBALLoT: Ct(or.trs E . Li arco -xs

+BALLOT DESIGNATION:

I DO NOT DESIRE TO HAVE A BALLOT DESIGNATION

Candidate's Initials
*Refer to Candidate Handbook for specific rules. Your ballot designation must be your principal profession, occupation,
or vocation. It must be no more than 3 words; however, if you currently hold elective office, you may use the full title of that
office.
**ALL CANDIDATES MUST COMPLETE IN FULL THE BALLOT DESIGNATION WORKSHEET.

CANDIDATES: PLEASE READ. INITIAL. AND SIGN rnstrurnent rs a copy ol tne 0r

I have received the following: information on file in this offlce.
An affidavit ofregistration shall be deemed
I The Candidate Handbook. _ Initial
evidence olcitizenship lor voting purposes only
I A Campaign Disclosure Kit. lnitial Electicns Code Section 2 I l2
f Th" l"tt.t from Department ofTransportation regarding f
f] Th. Cod. of Fair Campaign.Practices form. I am aware 1

voluntary. _ Initial ^rts

I I u* aware that candidate documents are public record
SIGNATURE OF CANDIDATE
-a!!!1!€arriJ,-
*a1r' -.- " e r. -aar-

PRECINCT- A,FFIDAVII #

PRECINCT AFFIDAVIT# REGDATE

NNo ISSUED-BY -firifii--

-
ToBEUSEDONNoMINATIONS:
Dat€
VALUE=S BALANCEDUE CAND.NOTIFIED

f, vALUE = $ BALANcE DUE cAND. NoTIFIED

(Continue on back ifnecessary for sigs in lteu offiling fee)

5 NoMINATION PAPERS & DECLARATION OF CANDIDACY: ISSUED

TO SEC OF STATE

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