HomeMy WebLinkAbout501s CANDIDATE INTENTION STATEMENT
Candidate Intention Statement Type or Print in Ink. Date Stamp
RECEWED FO • '
-' For Official Use Only
Check one: ',Initial ❑ Amendment (Explain) JUL 2 8 2003
CITY CLERKS DEP
1. Candidate Information:
NAME OF CANDIDATE (Ua, First. Midge mrtuq �i DAYTIME TELEPHONE NUMBER FAX NUMBER (opooneq E -MAIL N000ap
(JD ('4� -81,�g (��t3) 3o8 -I 9 s Aay.A e QY od C.
STREE OA� l5 STATE ZIP CODE
T T O O0 LJ7t IF _ \CJC� � �n7
OFFICE SOUGHT (POSITION TITL I) ' I AGENCY NAME
/ p IISTRI,T NUMBER, Wapp'imda NON- PARTISAN
C N C k M 'N t t J t o r lr�Z W G [ PARTY
OFFICE JURISDICTION
❑ State (c—per- Pan 2J
o (� f -tic . c� a
City County C'> -rut t UA
gore ear
2. State Candidate Expenditure Limit Statement:
(CaIPERS candidates, judges, judicial candidates, and candidates for local offices are not required to complete Part 2.)
2 — °-3 Primarylgeneral election ram a Speciallrunoff election
(Cr —tor)
❑ 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:
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 iI app'imNe)
r_1 On _ /_/ I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification:
I certify under p of perjury under the laws of the State of California t ' ti a re o' u nd ' ne
Executed on oix_q 2 n 6 Signature
(month, day. ye r) (CaMltlate)
FPPC Form 501 (Jan/03)
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