HomeMy WebLinkAboutReid Lerner - Form 501Candidate Intention Statement
Check One: Initial ❑Amendment (Explain)
Date Stamp
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NAME OF CANDIDATE (Lam, nrst Mille Initial,
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DAYTIME TELEPHONE NUMBER
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FAX NUMBER (optional, E -MAIL (optional,
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STREET ADDRESS
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CITY
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STATE ZIP CODE
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OFFICE SOUGHT (POSITION TITLE)
AGENCY NAME
DISTRICT NUMBER, a apptinble.
ON- PARTISAN
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PARTY:
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City ❑ County
El Multi-County: (Name of uxiCOUnry JUaseiaion) (Yeeoar)
2. State Candidate Expenditure Limit Statement:
(CalPERS and CaISTRS candidates, judges, judicial candidates, and candidates for locat offices do not complete Part 2)
(Year of EleGian) Primary/general election o/ Election) Special /runoff election
(Year
(Check one ear)
❑ 1 accept the voluntary expenditure ceiling for the election stated above.
❑ I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
O 1 did not exceed the expenditure ceiling in the primary or special election held on: Jam_ and I accept the voluntary expenditure ceiling for
the general or special runoff election.
(Mark a app"W
❑ On ---J---J, I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification:
certify under penalty of perjury under the laws of the State of California
(Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov