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501 Martin W3 (01-30-19) Initial_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 />/J <br />rjti.ri I /11 <br />STREET ADDRESS <br />CALIFORNIA 501 <br />FORM <br />For Official Use Only <br />DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) EMAIL (optional) <br />) <br />9 <br />CITY <br />vr5 ; e <br />STATE ZIP CODE <br />CA <br />OFFICE SOUGHT (POSITION TITLE) <br />(' : t <br />OFFICE JURISDICTION <br />❑ State (Complete Part 2.) <br />City ❑ County D Multi -County: <br />AGENCY NAM <br />DISTRICT NUMBER, if applicable. (NON-PARTISAN OFFICE <br />PARTY PREFERENCE: <br />zO <br />(Name of Multi -County Jurisdiction) (Year of Election) <br />(Check one box, if applicable.) <br />.®-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 />❑ 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. and I accept the voluntary expenditure ceiling for <br />the general or special run-off election. <br />(Mark if applicable) <br />❑ On <br />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 Califo ' he foregoing is true and correct. <br />Executed on 1 � Z, / Signature <br />'(month, da 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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