Form 501 Initial Candidate Intention Statement Date stamp CALIFORNIA 1
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Check One CITY OF ENCIHI j �;S For Official Use Only
Xrnitial ❑Amendment (Explain) CITY CLERK
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2010 AUG -9 Ali 11: 40
1. Candidate Information:
NAME OF CANDIDATE (Last,First,Middle Initial DAYTIME TELEPHONE NUMBER FAX NUMBER(optional) E-MAIL(optional)
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STREET ADDRESS CITY _ STATE ZIP CODE
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OFFICE SOUGHT(POSITION TITLE) AGENCY NAMEF DISTRICT NUMBER,if applicable. �[]NON-PARTISAN
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❑ State (Complete Part 2.) / -
A(Clty ❑ County ❑ Multi-County: (Name of Multi-County Jurisdiction) (Year of Election)
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2. State Candidate Expenditure Limit Statement:
(CalPERS and CaISTRS candidates,judges,judicial candidates, and candidates for local offices do not complete Part 2.)
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Primary/general election Special/runoff election
(Year of Election) (Year of Election)
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(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:
0 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)
❑ 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 Californi a e fore ng ' tru and Ct.
Executed on /0 �O ' 2,40 / Signature FPPC Form 501 (Jan/2016)
(month,day,year) (Candidat
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov