501 Candidate Intention Statement - Amendment Candidate Intention Statement D I (� �t���� � � • ' ' �
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Check One: ��nitial �mendment xplain) � �'��1�� � ` A�G _ � �16 � ���
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1. Candidate Information: �
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NAME OF/CQNDIDATE (�ast,First,Mid e Initial) ' FAX NUMBER(optionap
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OFFICE OUGHT(POSITION TITLE) AGENCY NAM� ` DISTRICT NUMBER, if applicable. pN-PARTISAN
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OFFIC�RISDICTION
Q Sta{g (Complete Part 2.) C'7 � //
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I .Cl,lty ❑ County ❑ MUItI-COUfItY: (Name of Multi-County Junsdiction) � (Year of Election)
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2. State Candidate Expenditure Limit Statement:
(Ca1PERS and CaISTRS candidates,judges,judicial candidates, and candidates for local o�ces do not complete Part 2.)
Primary/general election Special/runoff elecfion
(Year of Election) (Year oI Election)
(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:
� I did not exceed the expenditure ceiling in the primary or special election held on: _J—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 penalty of perjury under the laws of the
�� FPPC Form 501 (Jan/2016)
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(month,day,year) (Candidafe)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov