Loading...
HomeMy WebLinkAbout2017 Candidate Intention Statement EDE CALIFORNIA ORM 501 MAR 3 0 2W F Check One: AvoeJa�6 Fran. oFAt( For Official Use Only Initial mendment (Explain) CITY CLERKS DEP . 1. Candidate Information: NAME OF CANDIDATE (Last,First.Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER(optional) E-MAIL(optional) / )t -(_q" N ; JYllLhGel (Q�l ) 3oa',9S3 2- STREET ( ) fYllrhaPln�cfRy('KPf ('nYCowt l(d ADDRESS ( CITY STATE ZIP CODE 3OIZ Cn E PAV)CA T&-mr-cf_)cA (A l WSS9 Z OFFICE SOUGHT(POSITION TITLE) AGENCY NAME DISTRICT NUMBER, n applicable. �ON-PARTISAN C 1-1 7 cour1clt roerrocf T6-MECU t PARTY OFFICE JURISDICTION ❑State (Complete Pen 2.) City [I County ❑ Multi-County: ' '��L��� MulwCe�Vn myon) (Year 0 Ele6dion) 2. State Candidate Expenditure Limit Statement: (CalPERS and Ca1STRS candidates,judges,judicial candidates,and candidates for local offices do not complete Part 2J (Year of Election) (Year Primary/general election fEkcGon) Speciallrunotf election o (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: 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 i/applicable) ❑ On __JJ , 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 Q 3� y` 9JaOl- Signaturefl a (month,day,year) (Candidate) FPPC Form 501 (Jan/2016) FPPC Advice:advice@fppc.w.gov(866/275-3772) www.fppc.ca.gov