501 Candidate Intention Statement - Initial for 2018Candidate Intention Statement
Check One: nitial ❑Amendment (Explain)
JUL 2 5 VA
1. Candidate Information:
NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E-MAIL (optional)
C) W -5k y' 7"1Woty �, ( (
STREET ADDRESS f CITY STATE ZIP CODE
OFFICE SOUGHT (POSITION TITLE) AGENCY NAME ( DISTRICT NUMBER, i applicable. ON -PARTISAN
OFFICE JURISDICTION
C O N --ti b C° �o t
PARTY:
❑ State (Complete Part 2.)
VClty ❑ County ❑ Multi -County: Name of Multi -Coup Jurisdiction of
o
( b ) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(Ca1PERS and Ca/STRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
Primary/general election Special/runoff election
(Year of Election) (Year of Election)
(Check one box)
❑ I accept the voluntary expenditure ceiling for the election stated above.
❑ I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
0 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 fore oing is true and correct.
Executed on - ��" 1 Cl Signature!
(month, day, year) FPPC Form 501 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov