Form 501 Candidate Intention Statement M
w R.
CANDIDATE INTENTION STATEMENT
Candidate Intention Statement Type or Print in Ink. Date Stamp
CITY OF E CINITA'= OCALIFO R A 0 RM CITY CI_ERr
Check one: Initial ❑Amendment Ex lam or Official Use Only
( p 14 AUG AU l 2 A !4� 2°?
1. Candidate Information:
NAME OF CANDIDATE (Last First Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER(optional) E-MAIL(optional)
DISTRICT NUMBER,if applicable NON-PARTISAN
r Cl4 In PARTY
OFFICE JURISDICTION
❑State (Complete Part 2)
15(City ❑County El Multi-County (Name of Multi-County Jurisdiction) (Yea ion)
2. State Candidate Expenditure Limit Statement:
(Ca1PERS and CalSTRS candidates,fudges,judicial candidates,and candidates for local offices do not complete Part 2)
(Year of Electron)
Primarylgeneral electron (Year of Election) Speciallrunoff election
(Check one box)
1711 accept the voluntary expenditure ceding for the election stated above
❑I do not accept the voluntary expenditure ceding for the election stated above
Amendment
O 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 it applicable)
❑ 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 C ltforrna that the g i and t.
Executed onj ` / '/- Signa#ure
(month,day,year) nddata FPPC Form 501(April/2011)
FPPC Tall-Free Helpiine:8661ASK-FPPC(8661275-3772)