501 Candidate Intention andidate Intention Statement
Check One: ~ Initial ^ Amendment (Explain)
1. Candidate Information:
NAME OF CANDIDATE (Lass, First, Middle Initial)
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STREET ADDRESS R,t ,, // / "
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OFFICE SOUGHT (POSITION TITLE)
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AGENCY NAME
cITY
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FAX NUMBER (optbne/J E-MAIL (optional)
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STATE ZIP CODE
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DISTRICT NUMBER, if applicable.
For Official Use Only
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PARTY•
OFFICE JURISDICTION
^ State (Complete pan z) ~°
~( City ^ County ^Muiti-County: ~ 1 T ~ a r C ~ p ~1C Y~1~( t~ -~'t~ ~j
(Name dMulB-Count Jwisdlctlon) (Near or Election)
2. State Candidate Expenditure Limit Statement:
(CaIPERS candidates, Judges, judicial candidates, and candidates for local offices are not required to complete Part 2.)
•-•~•y .......... .....v.w.• .7f/C1:/tl//IY/lUII CIBGGOrI
(YearofE/ection) ••••• (YearotEJection)
(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 I 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 it applicable)
^ On _/_1 , 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
Type or Print In Ink.
DAYTIME TELEPHONE NUMBER
FPPC Form 501 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)