501 Intention andidate Intention Statement CANDIDATE INTENTION
· ndidate Information
FULL NAME OF CANDIDATE (LAST, FIRST, MIDDLE)
AODRESS~ ~ ~/
Io~'~ ~tp,.~.. 't::,,..-~.~ .,~ "L
CiTY
STATE ZIP COOE
DAYTIM~
('YO~ ) -:/- ~l (. _ -L ~ ~l0
..__.. C:. ,.., ¢,.. ,r- --/-,.,.., o
2. Office Sought
OFFICE SOUGHT (POSITION TITLE)
PL~LIC AGENCY NAME
DISTRICTNUMBER
~ ~ EEECTIVE OFFICE e o U GHT (~'-h~"c~-'-O~e-~'
[] STATE [] COUNTY O~~
FAX
E-MAIL (OPTIONAL)
~N I'~YE AR OF ELECTION
ECTION (CheckOne I1 Applicable)
o
3. Verification -------
I certify under penalty of perjury under lhe laws of the Slate of California that the foregoing is true and correct,
SIGNATURE OF CA~DI DtTE
FPPc Form S01 (8199)
· ' For Technical Asslslance: 916/322-5660