501 Candidate Intention andidate Intention Statement
Type or Prtnt In Ink.
Check One: ~J Initial ^ Amendment (Explain)
1. Candidate Information:
NAME OF CANDID (Last, First Middle Initial) //
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STREET ADDRESS /
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OFFICE SOUGHT (POSITION TITLE) //
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DAYTIME TELEPHONE NUMBER
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cITY
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For Official Use Only
CUPERTINO CITY CLERK
DUMBER (optlona/J E-MAIL (optional)
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DISTRICT NUI
ZIP CODE /
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AGENCY NAME ~
OFFICE JURISDICTION
^ State (Complete Part 2)
City ^ County ^Muiti-County:
(Name ofMultl-CounfyJurisdlcflonJ (year of Election)
2. State Candidate Expenditure Limit Statement:
(CaIPERS candidates, judges, judicial candidates, and candidates for local offices are not required to complete Part 2.)
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(Yearo/E/ec6on) (yearo/Elecfion)
(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: -1_j and I accept the voluntary expenditure ceiling for the
general or special run-off election.
(Mark!/applicable)
^ On _/_J , I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification:
I certify under penalty of perjury Hader the laws of the State of California
Toll-Free Helpline: 8661ASK-FPPC (8661275-3772)
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