501
Candidate Intention Statement Type or Print in Ink. ~~
Check One: ,.ø Initial D Amendment {Explain} ~[
¡etlPER~INO CITY CLERK
1. Candidate Information:
NAME OF CANDIDATE (Last, Firot, Midd/9 Initial) : TELEPHONE NUMBEF FAX NUMBER (optional) E-MAIL (optional)
SIWô.> J IrL- i /jolly ) 725-gQYI ( )
STREET ADDRESS , STATE
fD7à) Ikf)~()/<.. ~I' V PefLT/JI/.:>
OFFICE SOUGHT (POSITION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable. NON-PARTISAN
C-<.J (Jf-,rz...-r-i/ll J Clr'f G(/NC-Il--
OFFICE JURISDICTION
D State (Complete Part 2.)
)d'City o County o Multi-County: (Name of Multi-County Jurisdiction) (Year of El6clìon)
2. State Candidate Expenditure Limit Statement:
(CaIPERS candidates, judges, judicial candidates, and candidates for local offices are not required to complete Pari 2.)
Primary/general election Special/runoff election
(Year of Election) (YearofE/ectkHI)
(Check one box)
D I accept the voluntary expenditure ceiling for the election stated above.
D 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: ~--1_ and I accept the voluntary expenditure ceiling for the
general or special run-off election.
.....~
(Markifapplicable)
D On ~~_, I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification:
I certify under penalty 01 perjury under the laws 01 the State 01 Calilor. ng~correct.
Executed on Signatul
FPPC Form 501 (January/OS)
FPPC TolI·Free Helpline: 866/ASK-FPPC (866/275-3772)