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501 Booker CC W1 (08-17-17)_R
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Candidate Intention Statement <br />Check One: 01nitial ❑Amendment (Explain) <br />OF CANDIDATE (Last, First InitlaQ <br />Type or Print in Ink. <br />CitY of Riverside <br />i 'S Office <br />DAYTIME TELEPHONE NUMBER FAX NUMBER (optionaq E-MAIL <br />TITLE) AGENCY NAME DISTRICT NUMBER, If applicable. f71* T1T ceanceu <br />OFFICE JURISDICTION <br />❑ State (Complete Part z.) <br />® City ❑ County ❑ Mufti - County: (Name of Mule county Jurisdiction) (Year ms,) <br />2. State Candidate Expenditure Limit Statement: <br />(CaIPERS and Ca1STRS canddates, judges judicial candiates and candidates for bcal offices dD not complete Part 2.) <br />?,o a EE...) Primary /general efecdon (Yew of SpeclaUrunoff election <br />Ekxxim) <br />(Check one box) <br />❑ I accept the voluntary expenditure ceiling for the election stated above. <br />❑ I do not accept the voluntary expenditure ceiling for the election stated above. <br />Amendment: <br />0 1 did not exceed the expenditure ceiling in the primary or special election held on: I and I accept the voluntary expenditure ceiling for <br />the general or special run -off election. <br />(Mack if applcable) <br />❑ On —l_/ , I contributed personal funds in excess of the expenditure ceiling for the election stated above. <br />3. Verification: <br />I certify under penalty of perjury under the laws of going is true and correct. <br />Executed on Sig tu <br />(month, day, year) <br />FPPC Forth 601 (ApNU2011) <br />FPPC Toll -Fme Helpline: 866 /ASK-FPPC (866/276 -3772) <br />D <br />
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