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CANDIDATE INTENTION STATEMENT <br /> <br />Candidate Intention Statement TypeorPrintinlnk. <br /> <br /> For Official Use Only <br /> <br /> Check One: [] Initial [] Amendment (Explain) <br /> <br />1. Candidate Information: <br />NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E-MAIL (optional) <br /> <br />STREET ADDRESS CITY STATE ZIP CODE <br /> <br />OFFICE SOU6HT (POSITION TITLE! AGENCY NAME IDISTRICT NUMBER, /fspp/~ab/e. [] NON-PARTISAN <br /> I <br />OFF,CE ~UR,SD~CT,ON <br />[] State (co¢,~ Pa, z) <br />~City D County D Uulti-Coun~: (N~e of Jud~i~) ~ear of EleVen) <br /> <br />2. State Candidate Expenditure Limit Statement: ---~ ~ <br /> <br /> ~ I accept tho volunta~ oxpondituro ceilin~ [or the oloction stated abovo. <br /> <br /> ~ I do not ae~pt tho volunta~ oxponditure coilin~ for tho election statod above. <br /> Amondment: <br /> 0 I did not exceed the expenditure ceiling in the prima~ or special election held on: L~J and I accept the volunta~ expenditure ceiling for <br /> the general or special run-off election. <br /> <br /> (Ma~ ~ <br /> ~ On / / , I contributed personal funds in excess of the expenditure ceiling for the election stated above. <br /> <br /> 3. Verification: <br /> <br /> I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. <br /> <br /> Executed on ~ ~ ~' ~ ~. ~ ~ Signature /~c¢4¢Jr~- ~ <br /> v - (moath, day, year) ~ (Candidate) FPPC Form 501 (Jan/03) <br /> FPPC Toll-Free Helpline: 8661ASK-FPPC <br /> 8661275-3772 <br /> <br /> <br />