501 Candidate Intention Statement - Initial Candidate Intention Statement ^��o . - . �
� !� C� IsUU � � . -
CheCk �ne: For Official Use Only
'�p�ial ❑Amendment (Explain)
JUL 1 8 2016
CU��RT,, '� viTY CLERK
1. Candidate Information: � �nV �
NA E OF CANDIDATE a t,F�st,Midd�e rtiaq
STREETADDRESS l ,I L CITY
C�,��'T N GG��i `�v��tv L'� v �,i l�1 � ��.�-�7 i z,�� �
OF�FJ2�SOUGHT(POSITION TITLE) AGENCY NAME�. ! DISTRICT NUMBER,it app�icable. NON- RTISAN
_� �L� Ci�W�'�� � PARTY:
OFFICE JURISDICytC�N
❑ State ���f�plete Part 2.) '� Q/L
// f V
� Clty ❑ County ❑ MUItI-COUflty: (Name of Multi-County Juristliction) � (Year of Eleclion)
2. State Candidate Expenditure Limit Statement:
(Ca1PERS and Ca1STRS candidates,judges,ludicial candidates, and candidates for local o�ces do not complete Part 2.)
Primary/general election Special/runoff election
(Year o/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 the election stated above.
Amendment:
� I did not exceed the expenditure ceiling in the primary or special election held on: �_� and I accept the voluntary expenditure ceiling for
the general or special run-off election.
(Mark i/applicable)
❑ On �� , I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification:
I certify under pe alty f perjury under the laws of the
,_..--
Executed on � /l� , SignaturP�'�! FPPC Form 501 (Jan/2016)
� ( onth,day,year) (Candidate)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov