HomeMy Public PortalAboutForm 501 (2018 Election)Candidate Intention Statement
Check One:A R 1 8 2018 For Official Use
Initial ❑Amendment (Explain)
COTY CLERK
CITY OF CLAREPA097
1. Candidate Information:
NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E-MAIL (optional) 1
C ovx5eiL t � li'C 0 J 9-Y C - ('9091) 60 4- — ra7- Z ( ,,/ ( ) zCowVzc✓ � 61'", �l - Gaw✓
STREET ADDRESS CITY STATE ZIP CODE
OFFICE SOUGHT (POSITION TITLE) }� AGENCY NAME DISTRICT NUMBER, if applicable.NON-PARTISAN
Cl l/ 2'�bt OWIr t PARTY.
OFFICE JURISDICTION
❑ State (Complete Part 2.) -Lot
of O
City ❑ County ❑ Multi -County: (Name of MuttFCounty Jurisdiction) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(CalPERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
sear of Election) Primary/general election (year of Election) Special/runoff election
(Check one box)
❑ I accept the voluntary expenditure ceiling for the election stated above.
❑ I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
0 1 did not exceed the expenditure ceiling in the primary or special election held on: I and I accept the voluntary expenditure ceiling for
the general or special run-off election.
(Mark if applicable)
❑ On I , I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification:
certify under penalty of perjury under the laws of the State of California that the r going is true and correct.
3l Zol g __�__a-=-_
Executed on ) Signature
(month, day, year) Candidate) FPPC Form 501 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
wwwJppc.ca.gov