501 Candidate Intention StatementCandidate Intention Statement Type or Print In Ink. CANDIDATE INTENTION ST
CALIF U • - .
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For Official Use Only
Check One: : Initial ❑ Amendment (Explain) FHB 2 $ 204
1. Candidate Information: l;Ut'tH jIIVO YL
NAME OF CANDIDATE (Last; First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E -MAIL (optional)
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STREET ADDRESS CITY STATE ZIP CODE
OFFICE SOUGHT (POSITION TITLE) AGENCY NAME I DISTRICT NUMBER, if applicable.
c 1 t /`Lt PARTY:
OFFICE JURISDICTION If
❑ State (Complete Part 2.)
[City ❑ County ❑ Multi- County:
(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.)
r-r r7ratyiu6Tierai elecrion Speciai%f unon election
(Year of Election) (Year of Election)
(Check one box) .
❑ 1 accept the voluntary expenditure ceiling for the election stated above.
❑ I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
Q 1 did not exceed the expenditure ceiling in the primary or special election held on: I IF and I accept the voluntary expenditure ceiling for the
general or special run -off election.
(Mark if applicable)
❑ On I , I contributed personal funds in excess of the expenditure ceiling for the election stated above
3. Verification:
1 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 -- Signatur _�— �
(month, day, year) (Candidate)
FPPC Form 501 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)