Form 501 Candidate Intention Statement S
ti
Candidate Intention Statement Date Stamp •. •- '
1"I - :I1 0.
`(°"i°i' For Official Use Only
Check One: Pnitial ❑Amendment (Explain)
1. Candidate Information:
NA E OF CANDIDATE (Last,First Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER(optional) EMAIL( tional) t r
d- a--A -10-K 4gnc,�Pill
STRIEETADDRESS
(. �/ DISTRICT NUMBS ,if applicable. N-PARTISAN OFFICE
1 PARTY PREFERENCE:
OFFICE JURISDI ION (Check one box,if applicable.),
❑State (Complete Part 2.) �(� 'bKI�RIMARY/GENERAL
City ❑ County ❑ Multi-County: (Name of Multi-County Jurisdiction) eaElection) El
SPECIAL/RUNOFF
2. State Candidate Expenditure Limit Statement:
(CaIPERS and Ca1STRS candidates,judges,judicial candidates,and candidates for local offices do not complete Part 2.)
(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: _J--/ 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 pen Ity of pe jury under the laws of the State o Cali rnia that the fore Ing Is true and correct.
Executed on �� 24D Signature
(month,day,year) (candidate)' FPPC Form 501 (August/2018)
C) FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov