501 Candidate Intention Statement - Initial V �t: •ta�� t -ANDIDATE INTENTION STATEMENT
Candidate Intention Statement
Type or Print in Ink. 75) _ CALIFORNIA 501
FORM
Check One: rt Initial ❑Amendment (Explain)
JUN 3 0 2014 For Official Use Only
UPERTINO CITY CLERK
1. Candidate Information:
NAME OF CANDIDATE (Last,First,Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER(optional) E-MAIL(optional)
Ceti 61 OA k CY/ (
STREET ADDRESS CITY STATE ZIP CODE
OFFICE SOUGHT(POSITION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable. yiNON-PARTISAN
C T V £CL-1,1 CL41,5/2-rZiJ V L'z T Y PARTY:
OFFICE JURISDICTION
❑ State (Complete Part 2.) 1 �
yU
City ❑ County ❑ Multi-County: (Name of Multi-County Jurisdiction) (Year of Ele tion)
2. State Candidate Expenditure Limit Statement:
(CaiPERS and t;aiSTrS candidates,judges,judicial candidates, and candidates fur local offices Ju nut cornpieie Puri 2.)
Primary/general election Special/runoff election
(Year of Election) (Year of Election)
(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:
0 I did not exceed the expenditure ceiling in the primary or special election held on: and I accept the voluntary expenditure ceiling for
the general or special run-off election.
(Mark if applicable)
❑ On 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 SLCAM 3 0 r 7--e/ Signature ' ��•���
(month,day,year) 9 / (Candidate) /� FPPC Form 501 (April/2011)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)