HomeMy Public PortalAboutForm 510Candidate Intention Statement
Check One: Initial ❑Amendment (Explain)
AUG 3 0 2018
CITY CLERK
CIT I OF CLAREIWc
For Official Use Only
1. Candidate Information:
NAME OF CANDIDATE (Last, First Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) EMAIL (optional)
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STREETADDRESS CITY STATE ZIP CODE
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OFFICE SOUGHT (POSITION TITLE) 4i AGENCY NAME DISTRICT NUMBER, ifapplicable. NON-PARTISAN OFFICE
[PARTY PREFERENCE:
OFFICE JURISDICTION ` (Check one box, if applicable.)
❑ State (Complete Part 2.) Le PRIMARY / GENERAL
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vcity C]County ❑ Multi -County: (Name of Multi -County Jurisdiction) (Year of Election) ❑ SPECIAL/ RUNOFF
2. State Candidate Expenditure Limit Statement:
(Ca1PERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(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:
O 1 did not exceed the expenditure ceiling in the primary or special election held on:
the general or special run-off election.
and I accept the voluntary expenditure ceiling for
(Mark if applicable)
❑ On _j_J I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification:
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on q_-Sa, — 1 Signature 11 `�
(month, day, year) (candidate) FPPC Form 501 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov