HomeMy WebLinkAboutROBINSON 501 01/07/15Candidate Intention Statement
Type or Print in Ink.
Date Stamp
CANDIDATE
Check One: [Initial ❑Amendment (Explain)
wi iLL. Lt I, i I `f ou
1. Candidate Information:
NipOF CANDID AT (last, First, ddle Initial)
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DAYTIME TELEPHONE NUMBER
FAX NUMBER (optional) E -MAIL (optional)
1,
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AGENCY NAME
DISTRICT NUMBER, if applicable.
JON- PARTISAN
PARTY:
OFFICE JURISDICTION
❑ State (Complete Part 2.)
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;City El County El Multi-County:
(Name of Multi-County Jurisdiction)
(Year 'of�EVl�ectio�n)/
2. State Candidate Expenditure Limit Statement:
(CalPERS and Ca1STRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
Primary /general election Special /runoff election
(Year of Election) (Year of Election)
(Check one box)
❑ I accept the voluntary expenditure Ceiling for the election stated above.
❑ I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
0 1 did not exceed the expenditure ceiling in the primary or special election held on: —J I and I accept the voluntary expenditure ceiling for
the general or special run -off election.
(Mark if applicable)
❑ On I I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification:
certify under penalty of perjury under the laws of the State of C ' ornia that th regoing is true and correct.
Executed on L-7 / �" �� Signat
(month, day, year) (Can
FPPC Form 501 (ApriU2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)