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Candidate Intention Statement Type or Print in Ink. DateSramp <br /> Check One: �nitial <br /> 1. Candidate Information: <br /> NAME OF CANDIDATE (Last, irst,Middle Ini6al) <br /> �t�S�" �,�o�v�✓� <br /> STREET ADDRESS � <br /> <br /> <br /> <br /> S . <br /> CITy <br /> DAYTIME TELEPHONE NUMBER FAX NUMBER(op6onal) E-MAIL(op6onal) <br /> �%e�� �I��2C°-7� , , �r�,. ._ ,.� �.a �� <br /> ���vv cc;���n C-� � <br /> STATE ZIP CODE <br /> C� �t-(C f�S`� <br /> OFFICE SOUGHT(POSITION TITLE) AGENCY NAME DISTRICT NUMBER,if applicabie. ON-PARTISAN <br /> C1 �— CQ U�V�C 1 � Gt � L ������U O � ��� PARTY: <br /> OFFICE JURISDI TION <br /> � $tatg (Complefe Part 2.) <br /> [�City ❑ County ❑ Multi-Counry: �� � <br /> (Name of Mulli-Counly Jurisdiction) (Year of Eledion) <br /> 2. State Candidate Expenditure Limit Statement: <br /> (CaIPERS candidates,judges,ludicial candidates, and candidates for local o�ces are not required to complete Parf 2.) <br /> Primary/general election Special/runoff e/ection <br /> (Yearot E�ection) (Yearot E�ection) <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 /> Q I did not exceed the expenditure ceiling in the primary or special election held on: _�_� <br /> general or special run-off election. <br /> `��07 <br /> CITy <br /> /1.' ��' �!J 1��(.���T <br /> ���� <br /> and I accept the voluntary expenditure ceiling for the <br /> (Mark if applicable) <br /> ❑ On _J_J , I contributed personal funds in excess of the expenditure ceiling for the election stated above. <br /> 3. Verification: <br /> I certify under penalty o perj ry under the laws of the State of California that the foregoing ' true and cor ct. <br /> Executed on � � `�� , Signature �� � � <br /> (mo th,day,yea� <br /> (Candidate) <br /> FPPC Form 501(January/OS) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) <br />