HomeMy WebLinkAboutMBAGWU 501 08/03/14Candidate Intention Statement
Check One: [:1 Initial ❑Amendment (Explain)
n:
Type or Print in Ink.
Date Stamp
4 AUG —4 AM 11: 1� 1
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NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E -MAIL (optional)
M D-" t Cz C—
ZIP CODE
DISTRICT NUMBER, if applicable. ID NON - PARTISAN
PARTY:
OFFICE JURISDICTION
❑ State (Complete Part 2.) Ck
SkClty ❑County ❑ Multi-County: (Na,•/m ✓e offf M`u iCounty Ju iNiction) earofElectio
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) (Year of Election) Primary/general election Special /runoff election
(Check one box)
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 —Jl 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 foEgggigg is true and correct.
Executed on SOS �� Signature
(mo th, day, year) (Ca nd FPPC Form 501 (April /2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
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