Form 501 Candidate Intention Statement
Check One: -6 Initial F� Amendment (Explain)
1. Candidate Information:
NAME OF CANDIDATE (Last,First,Middle Initial) tA
STREET ADDRESS
OFFICE SOUGHT(POSITION TITLE) "+
L ' L 't�._ l I
NAME
Type or Print in Ink.
Date Stamp
�t if -1 -j t`1 12,
DAYTIME TELEPHONE NUMBER FAX NUMBER (optional)
CITY
it C_l I!1 I _�x=�
CANDIDATE INTENTION STATEMENT
E-MAIL (optional)
STATE ZIP CODE�j /
DISTRICT NUMBER, if applicable. NON-PARTISAN
For Official Use Only
PARTY:
OFFICE JURISDICTION
❑State (Complete Part 2.) t r
City ❑ County E] Multi-County: _ / E�f 1 t f ' -j <°
(Name of Jurisdiction) (Year of Election
2. State Candidate Expenditure Limit Statement:
(Ca1PERS candidates,judges,judicial candidates, and candidates for local offices are not required to complete Part 2.)
(Year of Election)
Primarylgeneral election (Year of Election) Speciallrunoff election
(Check one box)
❑ I accept the voluntary expenditure ceiling for the election stated above.
I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
Q 1 did not exceed the expenditure ceiling in the primary or special election held on: and I accept the voluntary expenditure ceiling for
the general or special run-off election.
(Mark if applicable)
R On I contributed personal funds in excess of the expenditure ceiling for the election stated above
3. Verification:
I certify under penalty of perjury under the laws of the State of California that the foregoing is tr�e and correct.
Executed on Signature �•'� _k ���'''�"`� L
(month,day,year) ( ndidate)
FPPC Form 501 (Jan/03)
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