HomeMy WebLinkAboutHaubert Form 501 08-10-2016 Amend_RedactedCandidate Intention Statement
Check One:
initial RAmendment (Explain)
Date Stamp
1. Candidate Information:
NAME OF CANDIDATE (Last, First, Middle Initial) FAX NUMBER (optional) E -MAIL (optional)
ST STATE ZIP CODE
OFFICE SOUGHT (POSITION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable. ip NON - PARTISAN
.Q 7 ✓ �
cv— �- 1 ' � iA ll PARTY:
OFFICE JURISDICTION
❑ State (Complete Part 2.) A
City ❑ County ❑ Multi- County: (Name of Multi -County Jurisdiction) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(CalPERS and Ca /STRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2)
(Year of Election)
Primary/general Year of Election)
mary/general election Special /runoff election
(Check one box)
❑ 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:
O 1 did not exceed the expenditure ceiling in the primary or special election held on: — I 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.
3. Verification:
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on §11 b I I Signature
(month, day, year) FPPC Form 501 (1an/2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov