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Candidate Intention Statement <br />Check One: ❑ Initial ❑ Amendment (Explain) <br />1. Candidate Information: <br />NAME OF CANDIDATE (Last First Middle Initial) <br />4 ( <br /> <br />e67 ,dWeok <br />OFFICE SOUGHT (POSITION TI E) rr <br />( At A CL 1 <br />OFFICE JURISDICTION <br />❑ State (Complete Part 2.) <br />City ❑ County ❑ Multi -County: <br />CAUDATE INTENTION STATEMENT <br />Type or Print in Ink. ") +[7wstawipmw If . <br />NIA <br />MAY 1 — 20 15 FORM 501 <br />IFor Official Use Only <br />CITY OF RE-01NOpp.C-ITY <br />CITY CLERK <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />STATE ZIP CODE <br />C14— gifo62 <br />I <br />DISTRICT NUMBER, if applicable. ®(NON-PARTISAN <br />PARTY: <br />�t 5 <br />(Year of Election) <br />Amendment: <br />Q 1 did not exceed the expenditure ceiling in the primary or special election held on: ��`� and I accept the voluntary expenditure ceiling for the <br />general or special run-off election. <br />(Mark it applicable) <br />❑ On _—J—J I contributed personal funds in excess of the expenditure ceiling for the election stated above. <br />3. Verification: <br />1 certify under penalty of perjury under the laws of the State of California that�th foregoing is true andcorrect. - <br />�r` r <br />Executed on 51112015 Signature <br />(mon(h, dal year) / (Can I e , <br />FPPC Form 501 (January/05) <br />FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-5772) <br />