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- ACandidate Intention tatement RECEIVE®Check One: Initial ❑Amendment (Explain) ,JUL 23 Official Use Only
CITY CLERKS DEP
1. Candidate Information:
�AME of CANDIDATE (Last,First Middle Initial) DAY IME TELEPHONE NUMBER FAX NUMBER(optional) EMAIL(optional)
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STREETADDRE S CITY STATE ZIP CODE `J v
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OFFICE SOUGHT(POSITION TITLE) AGENCY NAME DISTRICT NUMBER,if applicable. ❑NON-PARTISAN OFFICE
PARTY PREFERENCE:
OFFICE JURISDICTION (Check one box,if applicable.)
❑//State (Complete Part 2.) \� 9 IMARY/GENERAL
}y(Zity ❑County ❑ Multi-County: (Name of Multi-County Jurisdiction) (Year of Election) ❑SPECIAL/RUNOFF
2. State Candidate Expenditure Limit Statement:
(Ca1PERS and Ca1STRS candidates,judges,judicial candidates,and candidates for local offices do not complete Part 2.)
(Check one box)
❑I accept the voluntary expenditure ceiling for the election stated above.
❑1 do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
Q 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, _J_/ 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 Califor ' t the for is true and correct.
Executed on ~�W\'1 ��� Signature
(month,day year) (Candidate)
FPPC Form 501 (August/2018)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov