HomeMy WebLinkAbout2014 - Form 501 InitialCandidate Intention Statement
Check One: '*Initial ❑Amendment (Explain)
Information:
Type or Print in Ink.
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CANDIDATE INTENTION STATEMENT
NAME OF CANDIDATE (Last. First. Middle Initial) i DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E -MAIL (optional)
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STREET DRESS CITY STATE ZIP CODE
OFFICE SOUGHT (POSITION( TITLE) AGENCY NAME IDISTRICT NUMBER, if applicable. NON- PARTISAN
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L�JCi IP Ci�L �-� _'< <% ���L (LC9'I I PARTY:
OFFICE JURISDICTION
tttrrr ❑yyy State (Complete Part 2.)
l�l Clty ❑ County ❑ Multi- County: (Name of Multi-County Jurisdiction) (Yearn of Election)
2. State Candidate Expenditure Limit Statement:
(CalPERS and Ca1STRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(Year of Election)
Primary /general election (Year of Election) 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:
0 1 did not exceed the expenditure ceiling in the primary or special election held on: —J_l 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:
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on �-2, 1 Q Iva � � L� t Ar Signature � (o � ` mot` —
(month, day, year) (Candidate)
FPPC Form 501 (April /2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)