501 Candidate Intention Statement
Candidate Intention Statement
Type or Print in Ink.
Check One: ~ Initial
D Amendment (Explain)
1. Candidate Information:
NAME OF CANDIDATE (Last. First. Middle Initial)
S'lh +()r"O Ate rk tl..
STREET ADDRESS ) )
2.J'trl Lil'1,1 L.~e
OFFICE SOUGHT (POSITION TITLE)
C " ~ C () tA.J.,,:. i I
OFFICE JURIS ICTION
o State (Complete Part 2.)
DAYTIME TELEPHONE NUMBER
FAX NUMBER (optional) E-MAIL (optional)
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STATE ZIP CODE
CCAo
AGENCY NAME
(Cf4)J) r B" - 8 30t>
CITY
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CA
t:tS- 0 I If
DISTRICT NUMBER, if appticable.
ON-PARTISAN
Cil-
01
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PARTY:
~City
o County 0 Multi-County:
(Name of Multi-County Jurisdiction)
2oo~
(Year of Election)
2. State Candidate Expenditure Limit Statement:
(CaIPERS candidates, judges, judicial candidates. and candidates for local offices are not required to complete Part 2.)
(YearofEtection)
Primary/general election
(Year of Election)
Speciallrunoff election
(Check one box)
o I accept the voluntary expenditure ceiling for the election stated above.
o 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: -1-1_ and I accept the voluntary expenditure ceiling for the
general or special run-off election.
(Mark if applicable)
o On -1-1_. 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 ~ - ~ - 2 00 it Signature p~ - --.
(month, day. year) (Candidate)
F.PPC Form 501 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)