501 Candidate Intention Statement - Initial for 2018Candidate Intention Statement
Check One: Initial
1. Candidate Information:
NAM�F CANDIDATE (Last, First, Middle Initial)
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STREE
yT ADDRESS
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A ("G an (,`% � Mar,
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OFFICE SLIGHT (POSITION TITLE)
❑Amendment (Explain)
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AGENCY t
DAYTIME TELEPHONE NUMBER
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JUL 16 US
FAX NUMBER (optional) E-MAIL (optional)
OFFICE JURISDICTION
❑ State (Complete Part 2.)
City ❑ County ❑ Multi -County: Name of Multi -Coup Junsdic4on
i ( tY ) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(Ca1PERS and Ca/STRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
Primary/general election Special/runoff election
(Year of Election) (Year of Election)
1
PARTY:
Only
(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:
O 1 did not exceed the expenditure ceiling in the primary or special election held on: and and I accept the voluntary expenditure ceiling for
the general or special run-off election.
(Mark if 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 under the laws of the State of California that the foregoing is true and correct.
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FPPC Form 501 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov