HomeMy WebLinkAboutJan Marx - Form 501 - Initial - 05-02-2010CANDIDATe INTENTION, -\fI MENT
Candidate Intention Statement Type or Print in Ink. r-~te-Stamp-_CALlF-;RNIA '~'" 'O···'.~'}f1:..! I RECEIVED FORM .
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('1 For Official Use Only
Check One: ?{Initiat o Amendment (Explain) -------------
1. Candidate Information:
NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (opnonal) E-MAIL (optional)
J i+jV' HOl,.../(;~ L L /V\4'f::.2..)( ( ,,,, -', '
lOVY' ' STREET ADDRESS " CiTY STATE ZIP CO
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AGENCY NAME
C~'k DC-,J;n Lu"J Dfyjpo
o State (Complete Part 2.)
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')BCity o County o Multi-County: '(Name of Multi-County JurisdiCtion) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(CaIPERS candidates, judges, judicial candidates, and candidates for local offices are not required to complete Part 2.)
----::-:-_-=:----::--,---Primary/general election
(Year ofElection) (Year of Election)
(Check one box)
o I accept the voluntary expenditure ceiling for the election stated
----::-:-_-=:--.---.,-Speciallrunoff election
abo\/.
o I do not accept the voluntary expenditure ceiling for the elec"
Amendment:
o I did not exceed the expenditure ceiling in the ~ry or special election held on: -----.1-----.1__ and I accept the voluntary expenditure ceiling for the
general or special run-off election.
(Mark if applicable) /'
o On -----.1-----.1__, I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification:
! / '1 "
I'C Form 501 (JlanuaryI05)
FPPC Toll-Free Helpline: 866/AsK·FPPC (866/275-3772)
I certify under penalty of perjury under the laws of the State of California that t
~. 2-)._D/O
Executed on , Signature
(m th, day,fear)'