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410 Hemenway CC W7 (01-10-19)_R
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Last modified
5/20/2019 2:13:49 PM
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Candidate Intention Statement <br />Check One: Elnitial ❑ Amendment (Explain) <br />1. Candidate Information: <br />NziE OF CANDIDATE (Last, First Middle Initial) <br />rnen �aY / vefl 2S EETADDRESS <br />Vers/ r� <br />OFFICE SOUGHT (POS TION TITLE) ` AGENCY NAME <br />CjyJU`1 (r <br />OFFICE RISDICT ad �% <br />C <br />❑ State (Complete Part 2.) <br />p " ity ED County ❑ Multi -County: <br />DAYTIME TELEPHONE NUMBER <br />CITY <br />(V• ets( <br />(Name of Multi -County Jurisdiction) <br />city of Iv r Siaa, <br />FAX NUMBER (optional) EMAIL optional Qtyf I t Vit' i )•rice <br />( ) STATE <br />DISTRICT NUMBER, if applicable. <br />k.)afd' <br />ao11 <br />Et`ON-PARTISAN OFFICE <br />PARTY PREFERENCE: <br />(Check one box, if applicable.) <br />(Year of Election) <br />©-PfMARY / GENERAL <br />❑ SPECIAL / RUNOFF <br />2. State Candidate Expenditure Limit Statement: <br />(Ca1PERS and Ca1STRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.) <br />(Check one box) <br />01 accept the voluntary expenditure ceiling for the election stated above. <br />0 I do not accept the voluntary expenditure ceiling for the election stated above. <br />Amendment: <br />O I did not exceed the expenditure ceiling in the primary or special election held on: _/_/ and I accept the voluntary expenditure ceiling for <br />the general or special run-off election. <br />(Mark if applicable) <br />O On / / 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 the Stat ^f (`Elifnrnifl +hs++hc fnrcnninn ie +rt' end correct. <br />l <br />Executed on //O o/ ? Signature <br />(month, day, year) i (Candidate) <br />FPPC Form 501 (August/2018) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />
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