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Form 501 - Initial
Candidate Intention Statement Type or Print in Ink. y Date Stamp CANDIDATE INTENTION For Official Use Only Check One: © Initial ❑ Amendment (Explain) 1. Candidate Information: NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E -MAIL (optional) Gage, Donald F. ( 408 ) 842 -2968 ( ) STREET ADDRESS CITY STATE ZIP CODE 771 4th Street Gilroy CA 95020 OFFICE SOUGHT (POSITION TITLE) AGENCY NAME DISTRICT NUMBER, it applicable. ® NON - PARTISAN Mayor City of Gilroy I PARTY: OFFICE JURISDICTION ❑ State (Complete Part 2.) © City ❑ County ❑ Multi- County: (Name of Multi - County Jurisdiction) 2. State Candidate Expenditure Limit Statement: (CaIPERS candidates, judges, judicial candidates, and candidates for local offices are not required to complete Part 2.) Primary /general election Special /runoff election (Year of Election) (Year of Election) (Check one box) ❑ 1 accept the voluntary expenditure ceiling for the election stated above. ❑ I do not accept the voluntary expenditure ceiling for the election stated above. 2012 (Year of Election) Amendment: Q 1 did not exceed the expenditure ceiling in the primary or special election held on: —J —J and I accept the voluntary expenditure ceiling for the general or special run -off election. (Mark if applicable) ❑ On _lam 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 th regoin is rue and orrect. Executed on �' -/� -1 L Signature ` (month, day, year) (Candidate) FPPC Form 501 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)