HALF HOLLOW HILLS CENTRAL SCHOOL DISTRICT DIX HILLS, NEW YORK 11746 --------------------------------------------------------------------------In the Matter of the Expenditures and Contributions of ________________________________,
AFFIDAVIT
a candidate for the Board of Education of the Half Hollow Hills Central School District. --------------------------------------------------------------------------STATE OF NEW YORK
) )ss.:
COUNTY OF SUFFOLK __________________________, being duly sworn, deposes and says: (Candidate=s Name) 1.
This affidavit is submitted pursuant to the provisions of Education
Law Section 1528. 2..
The aggregate amount of all contributions received by me and/or
expenditures incurred by me, or by others with my approval, to aid my nomination and/or election to the Board of Education of the Half Hollow Hills Central School District did not exceed five-hundred dollars ($500.00) from the period _____________________ through and including _____________________. _____________________________ (Candidate=s Name) Sworn to before me this day of , 2013 _________________________ Notary Public HALF HOLLOW HILLS CENTRAL SCHOOL DISTRICT
DIX HILLS, NEW YORK 11746 --------------------------------------------------------------------------In the Matter of the Expenditures and Contributions of ________________________________,
AFFIDAVIT
a candidate for the Board of Education of the Half Hollow Hills Central School District. --------------------------------------------------------------------------STATE OF NEW YORK ) )ss.: COUNTY OF SUFFOLK __________________________, being duly sworn, deposes and says: (Candidate=s Name) 1. Law Section 1528.
This affidavit is submitted pursuant to the provisions of Education
2. The aggregate amount of all contributions received by me and/or the expenditures of all moneys or other valuable things paid, given, expended or promised by me, or incurred for or on my behalf by others with my approval to aid my nomination and/or election to the Board of Education of the Half Hollow Hills Central School District or to aid or influence the nomination or defeat of any candidate to be voted for at the election during the period ____________________ through and including __________________ were as follows*: _____________________________ $_____________________________ _____________________________ $_____________________________ _____________________________ $_____________________________ _____________________________ $_____________________________ 3. The total amount so expended or incurred by me during said period is $____________________________. ____________________________________ (Candidate=s Name) Sworn to before me this day of , 2013. _____________________________ Notary Public
*The required contribution statement shall include the dollar amount and/or fair market value of any receipt, contribution or transfer which is other than of money, the name and address of the transferor, contributor or person from whom it was received and if the transferor, contributor or person is a political committee as defined by Election Law '14-100 (1).