Form Cc-6 - Application For Public Funds - Campaign Spending Commission
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1STATE OF HAWAII
CAMPAIGN SPENDING COMMISSION
APPLICATION FOR PUBLIC FUNDS
1. CANDIDATE INFORMATION:
2.
Office Sought:
Candidate Name:
3.
District/County (if applicable):
/
4.
Primary
General
Election: (Check one)
Candidate Committee Name:
5.
Initial
Additional
Type of Application: (Check one)
$
6.
Application Total:
Social Security or
Employer Identification #:
(Enter total from the attached “Statement of Qualifying Campaign Contributions”)
(DAGS requires the # to process the check and comply with the IRC)
I hereby certify to the Campaign Spending Commission (“Commission”) that:
1.
I have filed 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;
2.
I have filed the “Statement of Intent to Seek Public Funds” form and agreed to all the conditions on that form;
3.
I am a qualified candidate on the election ballot in a primary or general election for which public funds are being sought;
4.
I have received the minimum qualifying contribution amount for my respective office as set forth in HRS, Section 11-429, once for the election
period and understand 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;
5.
I have electronically filed the “Statement of Qualifying Campaign Contributions” on the Commission’s Candidate Filing System and attached a
copy to this application;
6.
I understand that the Commission shall be under no obligation to provide moneys to candidates if moneys in the Hawaii Election Campaign
Fund are near depletion; and,
7.
The information on this application is true and accurate.
Candidate Signature
Date
Subscribed and sworn to before me
This
day of
, 20
Doc. Date:
# Pages:
Name:
First Circuit
Doc. Name:
Notary Public, State of Hawaii
My commission expires:
Notary Signature
Date
FOR OFFICE USE ONLY
1. Public Funds Approved for Distribution in Prior Applications
...................................................................................
2. Public Funds Approved for Distribution in this Application
…………………………………….……………….…..
3. Public Funds Approved for Distribution in this Election Period
………..……………………………………….......
Approved By
Date
Form CC-6 (Rev. 06/11)
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