501
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Candidate Intention Statement
o Amendment
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Candidate Information
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NAME OF CANDIDATE (Lasl, First, Middle Initial)
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STREET ADDRESS
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AGENCY NAME
OFFICE SOUGHT (POSITION TITLE)
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OFFICE JURISDICTION'
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Statement:
judicial candidates, and candidates for local offices Bre not
State Candidate Expenditure Limit
(CaIPERS candidates, judges,
2.
complete Part 2.)
required to
Special/runoff election
(Check one box)
~ accept the voluntary expenditure ceiling for the election stated above.
(YaarofE/ection)
Primary/general election
(YearofEfeclion)
the voluntary expenditure ceiling for the election stated above.
do not accept
Amendment
o I did not
o
accept the voluntary expenditure ceiling for the
and
---1---1_
exceed the expenditure ceiling in the primary or special election held on:
general or special run-off election
(Marklfapplicab/e)
o On ---1~_.
contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification
penalty or pe~ury under the iaws of the State of California that the foregoing is true and correct.
~O'S'
(month, day, year)
certify under
FPPC Form 501 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3n2)
(Candidate)
Signature
Executed on