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�._.�..� _ . i _. _ , <br /> CANDIDATE INTENTION STATEMENT <br /> Candidate Intention Statement Type or Print in Ink. ae amp , � . , <br /> � �—�� 1 <br /> �����E� ����� • - <br /> For Official Use Only <br /> Check One: �Initial ❑Amendment (Explain) AUu 01 2013 � <br /> � <br /> c�r�*�����.rt�a��ti���� <br /> 1. Candidate Information: �� � �- • <br /> NAME OF CANDIDATE (Last,First,Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER(optional) E-MAIL(optional) <br /> ��'� � ,�C�,v��5 r ����,, c65�) �r`7 —��i ( ) <br /> STREET ADDRESS CITY STATE ZIP CODE <br /> � � ct,;�1''�,� ��- 12e�;��w C, �tA- �iu U6� -I 3 t� <br /> OFFICE SOUGHT(POSITION TITLE) AGENCY NAME DISTRICT NUMBER, 'rf applicable. NON-PARTISAN <br /> Ci.l �l���.1 I C l �' �C�-t�(7Z�� f t <br /> PARTY: <br /> OFFICE JURISDICTI <br /> ❑ State (Complete Part 2.) �� <br /> `�Cit ❑ Count ❑ Multi-Count : ° <br /> y y Y (Name of Multi-County Jurisdidion) (Year of Election) <br /> 2. State Candidate Expenditure Limit Statement: <br /> (CaIPERS and CaISTRS candidates.ludges,judicial candidates, and candidates for local offices do not complete Part 2.) <br /> Primary/general election Special/runoff election <br /> (Year of Election) (Year of ElectionJ <br /> (Check one box) ' <br /> ❑ I accept the voluntary expenditure ceiling for the election stated above. <br /> ❑ I do not accept the voluntary expenditure ceiling for the election stated above. <br /> Amendment: <br /> � I did not exceed the expenditure ceiling in the primary or special election held on: —J� and I accept the voluntary expenditure ceiling for <br /> the general or special run-off election. <br /> (Mark if applicable) <br /> ❑ On _J� , I contributed personal funds in excess of the expenditure ceiling for the election stated above. <br /> 3. Verification: <br /> I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. <br /> vl ��I' � �t� f,3 , <br /> Executed on , Signature <br /> (month, day,year) (Candidate) FPPC Form 501 (April/2011) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) <br />