Form 501 Intention StatementCandidate Intention Statement
Check One. ►nitial
1. Candidate Information:
NAME OF CANDIDATE (Last First, Middle Initial)
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C/ / ex-
❑Amendment (Explain)
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Type or Print in Ink.
DAYTIME TELEPHONE NUMBER
0809 -25-08
Cj/7 /Tyrf-
CANDIDATE INTENTION STATEMENT
Date Stamp
CITY OF ENCI ITAS
CITY C1 FR'V'
20121AUG 15 Pit G• 41
FAX NUMBER (optional) E -MAIL (optional)
STATE ZIP CODE
CA iZo'-44
OFFICE SOUGHT (POS ION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable.
.y� /'� NON- PARTISAN
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PART`S
OFFICE JURISDICTION f
❑ State (Complete Pan 2.)
[City ❑ County ❑ MUlti- County•
(Name of Multi- County Jurisdiction) (Year of Election)
2. State Candidate Expenditure limit Statement:
(Ca/PERS and CalSTRS candidates. judges, judicial candidates, and candidates for local offices do not complete Part 2 )
Primary /general election Special /runoff election
(Year of Electron) (Year of Election)
(Check one box)
❑ 1 accept the voluntary expenditure ceiling for the election stated above
❑ I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
0 1 did not exceed the expenditure ceiling in the primary or special election held on —�_J and I accept the voluntary expenditure ceiling for
the general or special run -off election
(Mark if applicable)
❑ On _ —/_ _I 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 true and correct.
Executed on A S_ 2 0
Signature
(month, day, year) (Candidate)
FPPC Form 501 (April /2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661276 -3772)