HomeMy WebLinkAboutDEAN 501 AMEND 02/04/13Candidate Intention Statement � _
Type or Print in Ink.
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Date Stamp
13 FEB -5 AM g:
1. Candidate Information:
NAME OF CANDIDATE (Last, First. Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E -MAIL (optional)
STREET
OFF CE SOU HT (POSITION TITLE) AGENCY NAME RI TRICT NUMBER, if applicable. ON- PARTISAN
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PARTY:
OFFICE JURISDICTION
❑ State (Complete Part 2.)
City ❑ County ❑ Multi- County: ( Z `
Name of Multi- County Jurisdiction) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(Ca/PERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(Near or Election) (Year of Election)
Primary/general election SpeciaUrunoff election
(Check one box)
❑ 1 accept the voluntary expenditure ceiling for the election stated above.
❑ 1 do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
O 1 did not exceed the expenditure ceiling in the primary or special election held on: and I accept the voluntary expenditure ceiling for
the general or special run -off election.
(Mark it applicable)
❑ On _J_ J , 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 (�
Signature
(month, day, year) (Candidate) FPPC Form 501 . (April/2011)
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