HomeMy Public PortalAboutForm 501 InitialCandidate Intention Statement
Check One: ® Initial ❑Amendment (Explain)
1. Candidate Information:
NAME OF CANDIDATE (Last, First Middle Initial)
DAYTIME TELEPHONE NUMBER
JAN - 8 2020
Do] t,V,KA
FAX NUMBER (optional) EMAIL (optional)
Corey Calaycay ( )
STREETADDRESS CITY STATE ZIP CODE
1555 W. Baseline Road Claremont CA 91711
OFFICE SOUGHT (POSITION TITLE)
City Council
AGENCY NAME
City of Claremont
OFFICE JURISDICTION
❑ State (Complete Part 2.)
® City ❑ County ❑ Multi -County: (Name of Multi -County Jurisdiction)
2. State Candidate Expenditure Limit Statement:
(CaIPERS 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.
For Official Use Only
NON-PARTISAN OFFICE
IPARTY PREFERENCE:
(Check one box, if applicat
2020 ❑x PRIMARY/ GENERAL
(Year of Election) ❑ SPECIAL/ RUNOFF
Amendment:
O 1 did not exceed the expenditure ceiling in the primary or special election held on: and I accept the voluntary expenditure ceiling for
the general or special run-off election.
(Mark it applicable)
❑ On 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 12/19/2019 Signature L
(month, day, year) ( ndidate)\ '\1� FPPC Form 501 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov