501 Candidate Intention andidate Intention Statement Type or Print in Ink. Date stamp
Check One: ~ Initial ^ Amendment (Explain)
1. Candidate Information:
NAME OF CANDIDATE (Last, First, Middle Initial) I
STREET ADDRESS
~.
DAYTIME TELEPHONE NUMBER
(Yobs) P~6/ i<3oo
cITY
Ot Ylf-r2, o
STATE ZIP CODE
OFFICE SjOUGHT (PO/S~ITION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable. ANON-PARTISAN
C J T C., 0 ~h G/~ C Cit. C~^ /'~ v PARTY:
OFFICE JURISDICTION
^ State (Complete Part z.)
City ^ County ^Mnlti-County: C ~ f41 ~" ~/~ 0 2 Oo %'
(Name ofMulti-County Jurisdiction) (Year o/ Election)
2. State Candidate Expenditure Limit Statement:
(CaIPERS candidates, judges, Judicial candidates, and candidates for local offices are not required to complete Part 2.)
ZUU 'I Prfmarv/nonorwl olorlinn c.. .. -r.......u.,-.,_s:__
(Year of Election) (Year of Election)
(Check one box)
~,I accept the voluntary expenditure ceiling for the election stated above.
^ I do not accept the voluntary expenditure ceiling for th.e election stated above.
Amendment:
Q I did not exceed the expenditure ceiling in the primary or special election held on: -J-J
general or special run-off election.
and I accept the voluntary expenditure ceiling for the
(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 o/f~ perjury under the laws of the State of California that the foregoing is true and correct.
Executed on ~ `~ o ~ ~ U d ~ Signature ~'~~~-
(month, day, year) ~ (Candidate)
FAX NUMBER (optional) E-MAIL
( )
Ff 1 1 ~ FO` flffi~(~Us~~nl~ ~ r _ - -~
7~'
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FPPC Form 501 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/2753772)