HomeMy WebLinkAboutVEREEN 501 INITIAL 2/11/13INTENTION STATEMENT
Candidate Intenti n Statement
Check One: Initial ❑ Amendment (Explain)
Type or Print in Ink.
Date Stamp
FEB 111 AM 10 :16
1. Candidate Information "" " "" r (,i -LHK
NAME OF CANDIDATE (Last, First. Middle Initial) v v ee�, n a\ DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E -MAIL (optional)
/
STATE ZIP CODE
❑ State (Complete Part 2.)
1AClty ❑ County ❑ Multi-County: (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.)
Primary/general election W122 Special /runoff election
(Year of Election) (Year of Election)
(Check one bor)
❑ 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: and I accept the voluntary expenditure ceiling for
the general or special run -off election.
(Mark if applicable)
❑ On 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_be- State- of .California that the foregoing is true and correct.
Executed on �f- \-,, ( 1 0 o t Z Signature _
(month, day, year)
(Candidate)
FPPC Form 501 (April /2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)