501 Candidate Intention Statement
Candidate Intention Statement
Type or Print in Ink.
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Check One: 11 Initial
o Amendment (Explain)
1. Candidate Information:
NAME OF CANDIDATE (Last. First. Middle Initial)
MHL1AN~(R KAJ
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DAYTIME TELEPHONE NUMBER
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CITY
CU ertl/\D
AGENCY NAMI;
FAX NUMBER (optional)
STREET ADDRESS
STATE
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E-MAil (optional)
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ZIP CODE
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OFFICE SOUGHT (POSITION TITLE)
C \\'1 C00NC\L
DISTRICT NUMBER, if applicable.
NON-PARTISAN
C\TY 6F CU?e~TINO
PARTY:
OFFICE JURISDICTION
o State (Complete Part 2.)
~City
o County
D Multi-County:
26 () I
(Name of Multi-County Jurisdiction)
(Year of Election)
2. State Candidate Expenditure Limit Statement:
(CaIPERS candidates. judges, judicial candidates, and candidates for local offices are not required to complete Part 2.)
(Year of Election)
~rimary/general election
(Year of Election)
Special/runoff election
(Check one box)
o I accept the voluntary expenditure ceiling for the election stated above.
J not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
o I did not exceed the expenditure ceiling in the primary or special election held on: ----1----1_ and I accept the voluntary expenditure ceiling for the
general or special run-off election.
(Mark if applicable)
o On ---.1----1_. 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.
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Executed on n 5 I. Signature
(month. day, year) (Candidate)
F.PPC Form 501 (January/OS)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)