HomeMy WebLinkAboutJan Marx - Form 501 - Initial - 01-24-2012Candidate Intention Statement
Check One: )Initial ❑Amendment (Explain)
i. c:analnate inrormatlon:
NAME OF CANDIDATE (Last, First, Middle Initial)
W
OFFICE JURISDICTION
❑ State (Complete Part 2 )
WCity ❑ County
Type or Print in Ink.
DAYTIME TELEPHONE NUMBER
( &-:-) -5-vf — 2.7//'
D& 5'
❑ Multi-County: (Name of Multi -County Jurisdiction)
2. State Candidate Expenditure Limit Statement:
(CalPERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
CANDIDATE INTENTION STATEMENT
Date Stamp
RECEIVED
JAN 2Q 2,312
LO CITY CLERK
FAX NUMBER (opts } E -MAIL (optional)
q 3 1/-0 1
:T NUMBER. if applicable. Q NON - PARTISAN
PARTY:
D 0(2—
(Year of Election)
Primary /general election Special /runoff election
Post -Its"' brand fax transmittal memo 7671 # of pages ►
(Year of Election) (Year of Election) Flom
.� u d k_ tJ+UL'
(Check one box)
❑ I accept the voluntary expenditure ceiling for the election stated above.
6ept. Phone tt
Fax q Fax
❑ 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.
a u�
3. Verification:
I certify under penalty of perjury under the laws of the State alifornia that the foregoing is true and correct.
Executed on �" °2`� f,Z Signature
(month, d , year) (Candidate)
FPPC Form 501 (ApriU2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)
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Candidate Intention Statement
Check One: )<Initial []Amendment (Explain) _
. Ua
NAME OF CANDIDATE (Last, First, Middle Initial)
J�GrN/ M A
I�
Type or Print in Ink.
Dale Star
RECEIVE
'AM 2 4 2
LO CITY CL
DAYTIME TELEPHONE NUMBER FAX NUMBER
( Cs) -,5-v -1?/6 [ ) '
CA_
OFFICE JURISDICTION
❑ State (Complete Part 2.) i
WCity ❑ County ❑ Multi- County: (Mama of rfi,ai•caunty Jurisdiction)
(Year of E
2. State Candidate Expenditure Limit Statement:
(CalPERS and Ca1STRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.) Post -It" brand fax transn
Primary/general election __ Special /runoff election
(Year
(Year of Election)
of Eledian) i
i
(Check one box)
❑ I accept the voluntary expenditure ceiling for the election stated above.
,_�3 - 6 51
❑ 1 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 f accept
the general or special run -off election.
(Mark if applicable)
El !�I I contributed personal funds in excess
of the expenditure ceiling for the election stated above.
3. Verification;
s of the State o alifornia that the foregoing is true and correct.
I certify under penalty of perjury under the law
2`f Signature
Executed on jt andidate)
(month, de , yead FPPC 1
Ln
to
M
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O Y
Y M
M 00
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a} N
N N N
aq
Candidate Intention Statement
Check One: )<Initial []Amendment (Explain) _
. Ua
NAME OF CANDIDATE (Last, First, Middle Initial)
J�GrN/ M A
I�
Type or Print in Ink.
Dale Star
RECEIVE
'AM 2 4 2
LO CITY CL
DAYTIME TELEPHONE NUMBER FAX NUMBER
( Cs) -,5-v -1?/6 [ ) '
CA_
OFFICE JURISDICTION
❑ State (Complete Part 2.) i
WCity ❑ County ❑ Multi- County: (Mama of rfi,ai•caunty Jurisdiction)
(Year of E
2. State Candidate Expenditure Limit Statement:
(CalPERS and Ca1STRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.) Post -It" brand fax transn
Primary/general election __ Special /runoff election
(Year
(Year of Election)
of Eledian) i
i
(Check one box)
❑ I accept the voluntary expenditure ceiling for the election stated above.
,_�3 - 6 51
❑ 1 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 f accept
the general or special run -off election.
(Mark if applicable)
El !�I I contributed personal funds in excess
of the expenditure ceiling for the election stated above.
3. Verification;
s of the State o alifornia that the foregoing is true and correct.
I certify under penalty of perjury under the law
2`f Signature
Executed on jt andidate)
(month, de , yead FPPC 1