Laserfiche WebLink
Candidate Intention Statement <br />Check One: tial ['Amendment (Explain) <br />1. Candidate Information: <br />NAME OF CANDIDATE (Last. First Middle Initial) <br />D uiv(A N FI2CP( <br />STREET ADDRESS <br />IV <br />::=ALIFORNIA 501 <br />FORM <br />JAN 2 3 2019 <br />City of RiversidE <br />City Cleric's Offio <br />DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) EMAIL • .donal <br />For Official Use Only <br />CITY <br />OFFICE SOUGHT (POSITION TITLE) AGENCY NAME <br />CvvrYopRi vers�cI� <br />STATE ZIP <br />DISTRICT NUMBER, if applicable. E'WON-PARTISAN OFFICE <br />PARTY PREFERENCE: <br />OFFICE JURISDICTION <br />❑ State (Complete Part 2.) <br />[City 0 County 0 Mufti -County: <br />(Check rfe box, if applicable.) <br />RIMARY /GENERAL <br />(Name of Multi -County Jurisdiction) (Year of Election) ❑ 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 />❑ I 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 />❑ 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 true and correct. <br />Executed on <br />(month, , <br />ay,�o(q <br />year) <br />Signature _ <br />(Candidate) <br />FPPC Form 501 (August/2018) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />