HomeMy Public PortalAboutForm 501Candidate Intention Statement
Check One: b4itial E] Amendment (Explain) AUG 1 A 202 For Official Use Only
WY CLERK
CI"'V OF CLARSMON-
1. Candidate Information:
NAME OF CANDIDATE (Last, First Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) EMAIL (optional)
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SC/{' l 'S . 1 A iy CITY TE ZIP
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OFF E SOUGHT (POSITION TITLE) A ENCY AME (� DISTRICT NUMBER, if applicable. NON-PARTISAN OFFICE
v t f �` v PARTY PREFERENCE:
OFFICE JURI DICTION (Check one box, if applicable.) .
❑ State (Complete Part2.) ^� p� E:] PRIMARY/ GENERAL
&City ❑ County ❑ Multi -County: (Name of Multi -County Jurisdiction) (Year of Election) ❑ SPECIAL /RUNOFF
2. State Candidate Expenditure Limit Statement:
(CaIPERS and Ca1STRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(Check one box)
t,Laccept the voluntary expenditure ceiling for the election stated above.
❑ 1 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 /_/ and I accept the voluntary expenditure
ceiling for the general or special run-off election.
(Mark if 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 Ca ifornia that the foregoing is true and correct.
Executed on L � /)_�o Signature
(mon$, day, year) (Candidat FPPC Form 501 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov