HomeMy WebLinkAboutSMITH 501 INITIAL 7/23/14Candidate Intention Statement Type or Print in Ink. I Date Stamp
Check One: �nitial ❑Amendment (Explain)
NAME OF CANDIDATE (Last, First, Middle Initial)
DAYTIME TELEPHONE NUMBER
FAX NUMBER (optional)
E -MAIL (optional)
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STREET ADDRESS I
CITY
STATE
ZIP CODE
OFFICE SOUGHT (POSITION TITLE)
AGENCY NAME
DISTRICT NUMBER, if
applicable.
® NON - PARTISAN
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PARTY:
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OFFICE JURISDICTION
❑ State (Complete Part 2.) Z
[AClty ❑ County ❑ Multi-County: (Name of Multi- County Jurisdiction) (Year
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 (Year of Election)
/general election Special /runoff election
(Check one box)
❑ 1 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 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 foregoin s true and correct.
Executed on ' G �� Signature v
(month, day, year) (Candidate) f FPPC Form 501 (April/2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)