HomeMy Public PortalAbout00. Form 501 InitialCandidate Intention Statement
Check One: X
nitial ❑Amendment (Explain)
1. Candidate Information:
NAME OFCA TE (L sL First MJ AYTIME TELEPHONE NUMBER
S _�f
STREETAD ESS CITY
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OFFICE. SOUGHT (POSITION TITLE) A =INCY NAME
OFFICE JURISDICTION t
❑ State (complete Pan z.)X
City ❑ County ❑ Multi -County:
(Name of Multi -County Jurisdiction)
2. State Candidate Expenditure Limit Statement:
(Ca1PERS and Ca1STRS 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.
FAX NUMBER (optional) EMAIL
STATE ZIP CO
IS MCT NUMBER, if app❑OT
10zJ�
(Year of Election) El
For Official Use Only
TFSANt
TY
'FERENCE: -
pck one box, if appEl
PRIMARY / GENERAL
SPECIAL / RUNOFF
0
❑ 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 / / and I accept the voluntary expenditure
ceiling for the general or special run-off election.
(Mark if applicable)
❑ On, -__j _/ I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification: t
I certify under penalty of perunj under the laws of the S
�AFO
Executed on 7-6-7z' Signature
(month,arYear)
rrect.
FPPC Form 501 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov