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501 Rossouw CC W7 (01-22-19)_R
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Candidate Intention Statement <br />Check One: ® Initial ❑ Amendment (Explain) <br />1. Candidate Information: <br />NAME OF CANDIDATE (Last, First Middle Initial) <br />ROSSOUW MAARTIN J. <br />CALIFORNIA <br />FORM <br />DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) EMAIL (optional) <br />STREET ADDRESS <br />CITY <br />RIVERSIDE <br />OFFICE SOUGHT (POSITION TITLE) <br />CITY COUNCIL <br />AGENCY NAME <br />CITY OF RIVERSIDE <br />OFFICE JURISDICTION <br />❑ State (Complete Part 2.) <br />® City 0 County 0 Multi -County: <br />STATE <br />CA <br />ZIP CODE <br />DISTRICT NUMBER, if applicable. <br />SEVEN (7) <br />(Name of Multi -County Jurisdiction) <br />2019 <br />® NON-PARTISAN OFFICE <br />PARTY PREFERENCE: <br />(Check one box, if applicable.) <br />(Year of Election) <br />W PRIMARY/GENERAL <br />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 />1 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: and I accept the voluntary expenditure ceiling for <br />the general or special run-off election. <br />(Mark if applicable) <br />0 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 State of California that the foregoing is <br />Executed on JANUARY 22, 2019 Signature <br />(month, day, year) <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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