501 Candidate Intention Statement - Initial for 2018Candidate Intention Statement
Check One: LTJ Initial ❑Amendment (Explain)
1. Candidate Information:
� CSC E 0 V
Date Stamp
JUL 20201
For
CUPERTINO CITY bLERK
NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E-MAIL (optional)
do( ( )
STREET ADDRESS CITY STATE ZIP CODE -
c'fY
OFFICE JURISDICTION
❑ State (Complete Part 2.)
9 City ❑ County
cG arc <,I . ,-e lee
❑ Multi -County: T (Name of Multi -County Jurisdiction) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(Ca/PERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(Year of Election)
Primary/general election (Year of Election)Special/runoff election
(Check one box)
❑ I accept the voluntary expenditure ceiling for the election stated above.
PARTY:
❑ 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: -/_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 State of California that the foregoing is true and correct.
Executed on �z Z c/ 2a/ Signature
(m nth, day, year) ( FPPC Form 501 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov