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HomeMy WebLinkAboutNANCE 501 INITIAL 10/22/212Candidate Intention Statement Check One: Ainitial ❑Amendment (Explain) Type or Print in Ink. Date Stamp 22 PM 3: 35 1. Candidate Information: UAMtH6t ILLu Ci i Y CLERK NAME OF CANDIDATE (Last, First, Middle hitial) DAYTIME TELEPHONE NUMBER FAX NUMBER (oplional) E-MAIL (optional) *NGE---� ) ( c > STREET ADDRESS OFFICE SOUGHT (POSITION TITLE) AGENCY NAME � IDISTRICT NUMBER, f applicabe. NON- PARTISAN L l T \I ( i LV M C `T / o� KE12SREUD PARTY: OFFICE JURISDICTION ❑ State (Complete Part 2.) Z ©l.2 City ❑ County ❑ Multi- County: (Nam of Mrr6- county Junsdicfion) (Year of Election) 2. State Candidate Expenditure Limit Statement: (CabOERS and Ca/STRS candidates, judges, judicial candidates, and candidates for local offices do riot complete Part Z) Primary /general election SpeciaUrunoff election (Yea, a/ Efediar) rear o/ C- IecOion) (check — bo4 ❑ 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: 4 1 did not exceed the expenditure ceiling in the primary or special election held on: I -1 and I accept the voluntary expenditure ceiling for the general or special run -off election. (Abrk ff ❑ On I I contributed personal funds in excess of the expenditure ceiling for the election stated above. 3. Verification: I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on _ 2-C — 7 G t-7-- Signature ( —th, day, year) (Candidate) FPPC Form 501 (April/2011) FPPC Toll -Free Helpline: 866/ASK -FPPC (8681275 -3772)