501 Candidate Intention
Candidate Intention Statement
Type or Print in Ink.
Check One: 181 Initial
D Amendment (i:XG ai^)
1. Candidate Information:
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o State (Complele Part 2 )
~ City
o County
o Multi-County
2 () ()I
(Name of Multi-County Junsdlctlon)
(Year of ElectIOn)
2. State Candidate Expenditure Limit Statement:
(CaiPERS candidates. judges. ji.Jeilcfai candidates, and candidates fc;r iGCa! offices are not required ta complete Part 2.j
VearofEleC1lOn)
Primary/general election
Speciallrunoff election
('Year of EiectJoni
'Check one box)
o I accept the voluntary expenditure ceiling for the election stated above
Dido 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
(.~viark it applicable)
D On _!~-j_ 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 ~ue/;d ~corre~ct
Executed on _ / /!ill / t r Signature /-~ . _ ~
:mcntt? day. yearj (Candfdatej
FPPC Form 501 (January/05)
FPPC Toll-Free Helpl ine: 866/ASK-FPPC (866/275-3772)