HomeMy WebLinkAbout2016 Candidate Intention Statement teStamp O.
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Check One: Initial ❑Amendment (Explain) ""' 1 Q 9/►M
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1. Candidate Information:
N E OF CANDIDATE (Last,Fast,Middle INtlan DAYTIME TELEPHONE NUMBER FAX NUMBER IopGonap E-MAIL(opdonap
� V� , t9AM A (g�) ) 326 gk g, b c )
STREET ADDRESS CITY STATE ZIP CODE
C111 cwtNM CA, qzs� �
OFFICE SOUGHT(POSITION TITLE) AGENCY NAME DISTRICT NUMBER,if appl wble. WON-PARTISAN
I t MECUvY� PARTY:
OFFICE JURISDICTION
❑ State (Complete Part 2.)
y 2
01 ec,
hClty ❑ County ❑ Multi-County: (Name of Multi-County JuristliGion) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(CalPERS and CaISTRS candidates,judges,judicial candidates,and candidates for local offices do not complete Part 2.)
(Year o/EledlonJ
Primary/general election (Yeas oIEledloq Special/runoff election
(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:
O 1 did not exceed the expenditure ceiling in the primary or special election held on: __J__J and I accept the voluntary expenditure ceiling for
the general or special run-off election.
(Mark l/applicable)
❑ On I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification:
1 certify under penalty of perjury under the laws of the State of California that the fo oing is true and correct.
Executed on 03- �0- 201", Signature
(month,day,yea,) (Gantlitlafe) FPPC Form 501 (Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
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