501 (state stamped)
501
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Date Stamp
IE~IE
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Pri~~n Ink.
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2 20Œi
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Candidate Intention Statement
JUL
o Amen
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Check One:
00
o
AUG
CUPERTINO CITY CLERK
STATE lIP CODE
(A -=:¡S't>l4
DISTRICT NUMBER, if applicable. I~ON-PARTISAN
PARTY:
FAX
DAYTIME TELEPHONE NUMBER
S\IQ&
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Candidate Information
'-' 'i' ,*"l J2
1
?fXJS
(YearofElaction)
.\.\
o Multi-County:
(Complele Part 2.)
o County
(Nama ofMulr;..County Jurisdiction)
Statement:
for local offices are not
2. State Candidate Expenditure Limit
(CafPERS candidates, judges, judicial candidat6s, and candidates
required to complete Parl 2.)
SpeciaVrunoff election
(YearofE/edion)
(Checkonabox)
o I accept the voluntary expenditure ceiling for the election stated above.
Primary/general election
(YearofElection)
and I accept the voluntary expenditure ceiling for the
----1----1_
special election held on:
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
general or special run-off election.
o
contributed personal funds in excess of the expenditure ceiling for the election stated above.
(Marlci(applir;able)
o On ----1----1_.
F.PPC Form 501 (January/05)
FPPC TolI·Free Helpline: 866/ASK-FPPC (866/275-3772)
California
Signature
perjury under the laws of the State of
'2.-c7Ð $""
year)
\'ì
tho day.
3. Verification
under penaity of
.)~I
(m.
on
certify
Executed