Form Cc-4 - Statement Of Intent To Seek Public Funds - Campaign Spending Commission printable pdf download

STATE OF HAWAII

CAMPAIGN SPENDING COMMISSION

STATEMENT OF INTENT

TO SEEK PUBLIC FUNDS

1. CANDIDATE INFORMATION:

Office Sought:

Candidate Name:

District/County (if applicable):

Minimum Qualifying Contribution Amount

Candidate Committee Name:

(See the back of this form for this amount):

Maximum Amount of Public Funds Available in Each Election (Primary, General)

(See the back of this form for this amount):

I hereby notify the Campaign Spending Commission (“Commission”) of my intent to seek public funds for the purpose of paying expenditures

authorized in Hawaii Administrative Rules, Section 3-160-63. As a condition of receiving public funds, I agree:

To file the “Affidavit to Voluntarily Agree with Campaign Expenditure Limits” form to voluntarily agree to limit my expenditures and those

made on my behalf to an amount set for my respective office for each election as provided in Hawaii Revised Statutes (“HRS”), Section 11-423;

To obtain the required minimum qualifying contribution amount for my respective office as set forth in HRS, Section 11-429, once for the

election period; provided that no public funds will be available for a primary election if the minimum qualifying contribution amount is not

obtained before the date of the primary election. A qualifying contribution means an aggregate monetary contribution of $100 or less by an

individual Hawaii resident that is received after the filing of this “Statement of Intent to Seek Public Funds” form. A qualifying contribution

does not include loans, in-kind contributions, or the candidate’s own funds;

That qualifying contributions must be received during a matching payment period:

•

For a primary election, from January 1 of the year of a general election through the day of the primary election; and

•

For a general election, from January 1 of the year of a general election through the day of the general election.

An individual Hawaii resident may contribute $100 in the primary matching payment period, and may contribute $100 in the general matching

payment period;

To be a qualified candidate on the election ballot in a primary or general election to receive public funds for that election;

To have at least one other qualified candidate as an opponent for the primary or general election to receive public funds for that election;

To obtain and furnish any evidence relating to expenditures that the Commission may request;

To keep and furnish records, books, and other information that the Commission may request;

To an audit and examination by the Commission pursuant to HRS, Section 11-434, and to pay any amounts required to be paid pursuant to that

section.

I, the undersigned candidate for election to public office in the State of Hawaii, have read and understood the conditions of this statement.

Candidate Signature

Date

Form CC-4 (Rev. 01/11)

Form Cc-4 - Statement Of Intent To Seek Public Funds - Campaign Spending Commission