501 andidate Intention Statement
Check One: ~lnitial [] Amendment (Explain)
Type or Print in Ink.
INTENTION STATEMENT
For Official Use Only
1. Candidate Information:
DAYTIME TELEPHONE NUMBER
CITY
FAX NUMBER (op~onal) E-MAIL (op~rmO
STATE ZIP CODE
OFFICE SOUGHT (POSITION TITLE) ~ AGENCY NAME
0-~'~1 0-_0 0 ~ L WOfVt ¢~
OFFICE JURISDICTION
[] State (c.~m~e p~ z)
[~ty [] County [] Multi-County:
2. State Candidate Expenditure Limit Statement: ~/~,-
(CalPERS candidates, judges, judicial candidates, and candidates for lo_~ccal offices are not require~ to complefo Part 2.)
Primarylgeneral election
Speciallrunoff election
[] I accept the voluntary expenditure ceiling for the elect[on stated above.
[] I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
O I did not exceed the expenditure ceiling in the primary or special election held on:
the general or special run-off election.
! /
and I accept the voluntary expenditure ceiling for
[] on /
, I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3~ Verification:
~ certify under penalty of perjury under the laws of the State of California tha.~he foregoing is true and correct.
FPPC Form 50~ (Jan/03)
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86612753772