501 Candidate Intention Statment - Initial Candidate Intention Statement L� � L� � v L •. �
� D i For Official Use Only
Check One: Initial ❑Amendment (Explain) - !
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1. Candidate Information: CUPERTIe��O CITY CLERK
NAME OF CANDIDATE (Last,First,Midd�e Initiap
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OFFICE SOUGHT(POSITION TITLE) ( AGENCY NAME � IDISTRICT NUMBER, if applicable. I�NON-PARTISAN
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PARTY:
OFFICE JURISDICTION �
❑ Sta{g (Complete Part 2.) �v � �
�Cilty ❑ County ❑ MUItI-COUfItY: (Name of Multi-Counry Jurisdiction) � (Year of Election)
2. State Candidate Expenditure Limit Statement:
(CaIPERS and CaISTRS candidates,judges,judicial candidates, and candidates for local o�ces do not complete Part 2.)
Primary/general election Special/runoff election
(Year o/Election) (Year o!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: —�—J 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
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Executed on 9 FPPC Form 501 (Jan/2016)
(month,day,year) (Candidate)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov