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2019 Plochor_John CC W3
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501 Plochor CC W3 (01-18-19)_R
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5/22/2019 3:20:31 PM
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Candidate Intention Statement <br />Check One: Effnitial ❑Amendment (Explain) <br />JAN 18 2019 <br />City of Riv ide <br />ity Cie- k's Office <br />For Official Use Only <br />1. Candidate Information: <br />NAME OF CANDIDATE/(I�St1. First Midde Initi)) <br />�r 0 t Aok 1t! h Ii 11 <br />STREET ADDRE ` CIS <br />DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) <br />STATE <br />OFFICE SOUGHT (POSmON TITLE) <br />OFFICE JURISDICTION <br />❑ $ (Complete Part 2) <br />City 0 County ❑ Mutti-County: <br />ENCY NAME <br />STRICT NUMBER, if applicable <br />3 <br />(Name of Multi -County Jurisdiction) <br />ON -PARTISAN OFFICE <br />PARTY PREFERENCE: <br />(Year of Election) <br />(Check box, if applicable.) <br />Y / GENERAL <br />0 SPECIAL / RUNOFF <br />2. State Candidate Expenditure Limit Statement: <br />(CaIPERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2) <br />(Check one box) <br />❑ I accept the voluntary expenditure ceiling for the election stated above. <br />❑ 1 do not accept the voluntary expenditure ceiling for the election stated above. <br />Amendment: <br />Q 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 />0 On _J_J 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 State of Califomia t is true and correct. <br />Executed on fon/le/9 Signature <br />(, year) <br />FPPC Form 501 (August/2018) <br />FPPC Advice: - ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />
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