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HomeMy WebLinkAboutCCDR - Bernard Wolff - 09/08/2009RECEIVED Q V...... nnT V— 10/AS? SEP - 8 2009 State Ethics Commission > '? DECLARATION OF INTENTION TO ACCEPT CAMPAIGN CONTRIBUTION f '1,7 CM of M FOrrri DOI IL'PON I Today'sDate: �fO9 / Candidate pp , ,, l (Full Name):i(i14i>(?.11 LQ� L- �-` C��l�, !XJ©LAc:�/F Address: 2 City, State, Zip: /ill, %QA) 1 � -S©© 7- - 6 T nz:l G��GZ Telephone Number (Optional): Q�� '-r and/or Name of Office Sought (include district, post or judicial circuit, if applicable) Party Affiliation (Optional): State: C 4 ❑ Democrat 3 fi t ( w ❑ Republican County: ❑ Non Partisan , 11 Municipal: I%1 / L SGV 6>d Y �1iL1iC��ilL- ❑ Other 4 Incumbent Name: ft� �� , } Election Year: Complete additional information below ONLY if you have a campaign committee. This information does not register a campaign committee. (Please use Form RC to do so.) Campaign Committee �j ' &^q �ia:5'S/ AA)k) J,LA�Z7 Chairperson (Full Name): 5 Address: 1, "'z za(44 City, State, Zip: LW LL" �4 !C L --T-422 Z -f ��45� Treasurer (Full Name): 52 4 -J -d/ 6 Z-Obe-" x Address : <C4- City, State, Zip: I CERTIFY THAT THIS STATEMENT IS COMPLETE, TRUE, AND ACCURATE. 14 Signature of Candldat Date MAIL TO: THE APPROPRIATE FILING OFFIUER