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CANDIDATE INTENTION STATEMENT <br />Candidate Intention Statement Type or Print in Ink. <br /> <br /> For Official Use Only <br /> Check One: ~ Initial [] Amendment (Explain) <br /> <br />1. Candidate Information: <br />NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (opt~nal) E-MAIL (optional) <br /> <br />STREET AD~)RESS CI~ STATE ZIP CODE <br /> <br /> ~ City ~ County <br /> <br />2. State Candidate Expenditure Limit Statement: <br />(~IPERS candidates, judges, judi~al candidates, and candida~s for local offices a~ not ~qui~d to ~pleth Pa~ 2.) <br /> <br /> ~ I accept the volunta~ expenditure ceiling for the election stated above. <br /> ~ I do not accept the volunta~ expenditure ceiling for the election s~ted above. <br /> Amendment: <br /> O I did not exceed the expenditure ceiling in the pr[ma~ or special election held on: i / and 1 accept the volunta~ expenditure ceiling for <br /> the general or special run-off election. <br /> <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 /> (month, day, year) ' - (Ca~oT~a~) -~ ~ ' <br /> FPPC <br /> Form <br /> 501 <br /> (Janl03) <br /> FPPC TolI-F~e Helpline: 866/ASK.FPPC <br /> 866/275-3772 <br /> <br /> <br />