501 Candidate Intention Statement - Initial for 2024Candidate Intention Statement
Check One: 0Initial ❑Amendment (Explain)
1. Candidate Information:
pECE0VE
Jf' e Stamp
tJ 2024
PERTINO CITY CLER
For Official Use Only
NAME OF CANDIDATE (Last, First Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) EMAIL (optional)
C qA� G-r , 5k R-C x, ( �' ( )
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OFFICE SOUGHT (POSITION TITLE) N-
) AGENCY NAME DISTRICT NUMBER, if applicable. OPARTISAN OFFICE
C Zr -C< Ga cl/V f� kA �N( B0-R C �rC)7- ? PARTY PREFERENCE:
OFFICE JURISDICTION (Check one box, if applicable.)
❑ State (Complete Part 2.) PRIMARY / GENERAL
j City ❑ County ❑ Multi -County: C 1 O (Name of Juddiction)D (Year o� SPECIAL / RUNOFF
2. State Candidate Expenditure Limit Statement:
(CaIPERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(Check one box)
❑ I accept the voluntary expenditure ceiling for the election stated above.
❑ 1 do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
Q 1 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 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 ` / / _ / Signature
(month, day, year) (Candidate)
Form 501 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov