501
Type or Print In Ink.
(ExplaIn)
Candidate Intention Statement
o Amendment
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DAYTIME TELEPHONE NUMBER
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Candidate Information
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DISTRICT NUMBER, if app/¡;;;¡;¡;
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NAME OF CANDIDATE (Lasl, First, Middle Initial)
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STREET ADDRESS
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NON-PARTISAN
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AGENCY NAME
OFFICE SOUGHT (POSITION TITLE)
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OFFICE JURISDICTION'
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Statement:
judicial candidates, and candidates for local offices Bre not
State Candidate Expenditure Limit
(CaIPERS candidates, judges,
2.
complete Part 2.)
required to
Special/runoff election
(Check one box)
~ accept the voluntary expenditure ceiling for the election stated above.
(YaarofE/ection)
Primary/general election
(YearofEfeclion)
the voluntary expenditure ceiling for the election stated above.
do not accept
Amendment
o I did not
o
accept the voluntary expenditure ceiling for the
and
---1---1_
exceed the expenditure ceiling in the primary or special election held on:
general or special run-off election
(Marklfapplicab/e)
o On ---1~_.
contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification
penalty or pe~ury under the iaws of the State of California that
Executed on