Form 501 - 2014 InitialCandidate Intention Statement
Check One: [v(lnitial ❑Amendment (Explain)
ate
Type or Print in Ink. iPte stamp
CANDIDATE INTENTION STATEMENT
NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E -MAIL (optional)
ter �,e Aoz (yog) y a 7 - y b9 7 ( )
STREET ADDRESS CITY STATE ZIP CODE
43a00 r Je. r- J 0 2 L, t� c 95oaq
OFFICE SOUGHT (POSITION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable. NON - PARTISAN
COUnCt Q CI U PARTY:
OFFICE JURISDICTION
❑ State (Complete Part 2.)
14 Clty ❑ County ❑ Multi-County: (Name of Multi- County Jurisdiction) (Year of
2. State Candidate Expenditure Limit Statement:
(CalPERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(Year of Election)
Primary/general election (Year of Electron) Special /runoff election
(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:
Use Only
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 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 California that the foreg ing is true and correct.
Executed on 1 t) 4 e ( V 1 Sig
(month, day, year) (Candid.) FPPC Form 501 (April /2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)