HomeMy WebLinkAbout2010 C andidate Intention Statement Type or Print in ink. d CANDIDATE INTENTION STATEMENT � CALIF ,
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Check One:. - Initial _- []Amendment (Explain)
]ATY CLEnK.15 BE . P T
JUL 2 9 2010 For Official Use Only
1. Candidate Information:
NAME OF CANDIDATE (Lest, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E -MAIL (optional)
STREET A �� ti(N �1U ►4(� -�D iSS� `a o �j c )�L w �, eo:�,�15_�' �-1 ur�e,� �. C cm�l
DDR S CITY S TAX E ZIP CODE
(-C `7 U l /� J An
OFFICE SOUGHT (POSITION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable. I ffi& FN-PARTISAN
Etf C a AC � L C� PARTY:
OFFICE JURI DICTION
❑ State (Complete Part 2.)
ity ❑ County ❑ Multi- County: G ( d
(Name of Multi -County Jurisdiction) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(CalPERS candidates, judges, judicial candidates, and candidates for local offices are not required to complete Part 2.)
(Year of Election)
Primary/general election Special /runoff 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:
Q 1 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 erjury under the laws of the State of Califo nia th t the going ' rue and correct.
Executed on oZ� d Signature
(coon h, day, year) (Candidate)
FPPC Form 501 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)