HomeMy WebLinkAboutNehmeh, Joshua - 2012 FPPC Campaign Disclosure Forms For 201 (2)A_
CANDIDATE INTENTION
Candidate Intention Statement
Check One: DnInitial ❑Amendment (Explain)
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1. Candidate Information: T,-5
NAME OF CANDIDATE (Last, First, Middle Initiali
Type or Print in Ink. r_, Date stamp..
DAYTIME TELEPHONE NUMBER
c -714 4s� 5"78I
FAX NUMBER (optional)
E-MAIL (optional)
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STREET ADDRESS CITY r STATE X `01 CODE j
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OFFICE SOU+G(HjT ((P_OSIITTI /OWN TITLES] J AGENCY NAME DISTRICT
�NUMBER, if applicable. NON -PARTISAN
_�/" / /lVCR' f�i� W44 — (/ v/rT ..PARTY:
OFFICE JURISDICTION
❑ State (Complete Part 2.) ���
I 0-City ❑ County ❑ MUlti-CQUnt :��
y (Name of Multi -County Jurisdiction) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(CalPERS and CalSTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
Primary/general election Special/runoff election
(Year of Electron) (Year of Electron)
(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:
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 j1__—_, I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification:
I certify under penalty of 7perjury under the laws of the State of Ca ' regoing is true and correct.
Executed on 11510 7//& Signatur
— I (month, day, year)
FPPC Form 501 (April12011)
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)