HomeMy WebLinkAboutGrow, Heather Lyn - 2009 FPPC Campaign Disclosure Forms For (2)Candidate Intention Statement
Check One: *itial ❑ Amendment (Explain)
1. Candidate Information:
N E OF CANDIDATE (Last, First, Md le Initial)
Type or Print in Ink.
DAYTIME TELEPHONE NUMBER
(714)'U/1-1,7,4(
CANDIDATE INTENTION STATEMENT
Date Stamp
2009 OCT 20 Phi 12: 08
FAX NUMBER (optional) E-MAIL (optional)
r 1
City ❑ County ❑ Multi -County:
(Name of Multi -County Jurisdiction) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(Ca1PERS candidates, judges, judicial candidates, and candidates for local offices are not required to complete Part 2.)
(Near of Election) (Yearof Election)
Primary/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:
Q 1 did not exceed the expenditure ceiling in the primary or special election held on:
general or special run-off election.
For Official Use Only
and I accept the voluntary expenditure ceiling for the
(Mark if applicable)
❑ on _J—J I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification:
I certify under penalty of perjur under the laws of the State of California_t at the foreg in . true_ nd rect.
Executed on Signature
(moot ,day, yearj di a e)
FPPC Form 501 (January/05)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)