Form 501 Candidate Statement Candidate Intention Statement CITY 0i: ,:i oaleStamp CALIFORNIA ,
FORM i.! C
Check One: For Official Use Only
nitial ❑Amendment (Explain) c( ' I .. ij J i
1. Candidate Information:
NAME OF CANDIDATE (Last,First,Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER(optional) E-MAIL(optional)
�soov Pcu�l Q . _ (?60 ) g��— ZlR6 x(601 612— lot t �fe• �parptro'i
6.0(il CA 120
OFFICE SOUGHT(POSITION TITLE) AGENCY NAME
� rr DISTRICT NUMBER,l)applicable. ON-PARTISAN
pr PARTY:
OFFICE RISDICTION
❑ State (Complete Pad 2.) Wzo(c
City ❑ County ❑ Multi-County: (Name of Muni-county Judsdialon) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(CalPERS and CalSTRS candidates,judges,judicial candidates, and candidates for local offices do not complete Part 2)
(Yam,pl electron) Primary/general election rear or Ekcrpn) Special/runoff election
(Check ono 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:
O 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 ---J___J 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 -2T Zo Il. Signature — _.
(month,day,year) ( �adate) FPPC Form (tan/2016)
FPPC Advice:advice @ (86 fppc.ca.gov(866/275-3772)
www.fppc.ca.gov