Form 501 - 2016 InitialCandidate Intention Statement
Check One: ®Initial ❑Amendment (Explain)
Date Stamp
FFB / is
6
NAME OF CANDIDATE (Last, First, Middle InRteq DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E -MAIL (optional)
Velasco, Roland ( 408 ) 710 -8508 ( roland @rolandvelasco.com
STREET ADDRESS CITY STATE ZIP CODE
Bunting Court
SOUGHT (POSITION
ICE JURISDICTION
❑ state (Complete Part 2.)
AGENCY NAME
of
6K
CA 95020
DISTRICT NUMBER, if applicable. 11
® City ❑ County ❑ Multi- County: 2016
(Name of MultlLounty Jurisdiction) (Near of Election)
2. State Candidate Expenditure Limit Statement:
(CatPERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
ear or ran) Primary/general election (�aar e�tion) SpeclaYrunoff election
(Check one box)
❑ I accept the voluntary expenditure ceiling for the election stated above.
NON - PARTISAN
PARTY:
❑ 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 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 true and correct.
Executed on February, 16, 2016 Signature
(month, day, year) (Candidate) FPPC Form 501 (Jan /2016)
FPPC Advice: advice@fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov