Laserfiche WebLink
Candidate Intention Statement <br />Check One: <br />Initial ❑Amendment (Explain) <br />1. Candidate Information: <br />NAME OF CANDIDATE (Last, First, Middle Initial) <br />(eche i A:Ak <br />STREET ADDRESS <br />FEB I G 2Ui <br />City ofe <br />City. C1E k's <br />DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E-MAIL (optional) <br />(6151) (O&J-- OS(% ( )IMPI <br />CITY pp STA <br />For Official Use Only <br />OFFICE SOUGHT (POSITION TITLE) AGENCY NAME <br />t s ..0.t <br />OFFICE JURISDICTION <br />❑ State (Complete Pad 2.) <br />City ❑ County 0 Multi -County. <br />DISTRICT NUMBER, if applicable. NON-PARTISAN <br />Wad PARTY: 0 <br />(Name of Multi -County Jurisdiction) <br />O V7 <br />(Year of Election) <br />2. State Candidate Expenditure Limit Statement: <br />(Ca!PERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.) <br />Primary/general election <br />(Year of Election) <br />Special/runoff election <br />(Year of Election) <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 I did not exceed the expenditure ceiling in the primary or special election held on. /_J and I accept the voluntary expenditure ceiling for <br />the general or special run-off election. <br />(Mark if applicable) <br />0 On / / , 1 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 the Sta (California that the foregoin is true and correct. <br />Executed on I 61-01 Signatu <br />(month, day, year) r (Ca didate) <br />FPPC Form 501 (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />