HomeMy WebLinkAboutHANSON 501 12/09/14Candidate Intention Statement Type or Print in Ink. Date Stamp CANDIDATE INTENTION STATEMENT '
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Check One: �.lnitial 17-1Amendment (Explain) For Official Use Only
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1. Candidate Information:
NAME OF ANDIDATE (Last, First, Middle Initial) ( DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E -MAIL (optional)
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OFFICE SOUGHT (POSITION TITLE) AGENCY NAME DISTRICT NUUjMBER, if applicable. NON - PARTISAN
�l l 1.� (/� + �(- I�� i�LV S'l f e�� ✓ PARTY:
OFFICE JURI ICTION
❑ State (Complete Part 2.)
�Clty [I County E] Multi-County: (Name of Multi -County Jurisdiction) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(CalPERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(Year of Election)
Primary/general election (Year of Election Special /runoff 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:
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 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 o lifornia that the fore oing is true and correct.
f/
Executed on ("� ! -4 Signature
(month, day, year) (Candid te)
FPPC Form 501 (April /2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)