HomeMy WebLinkAboutBernald Form 501Candidate Intention Statement
Check One: ❑ Initial ❑ Amendment (Explain)
on:
Date Stamp
RECEIVED_
H! AY - ? 2010
ITY OF ', AARATOGA
NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E-MAIL (optional)
P BernaH ( + c
STREET ADDRESS CITY STATE ZIP CODE
AGENCY NAME DISTRICT NUMBER, if applicable. NON-PARTISAN
COUAy 1\ me-mbe-r Ct� np so-ro-toga-
PARTY:
OFFICE JURISDICTION
❑ State (Complete Part 2.) 2013
fCity ❑ County ❑ Multi -County: (Name of Multi -County Jurisdiction) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(CalPERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(Year of Election)
Primary/general election (Year of 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: and I accept the voluntary expenditure ceiling for
the general or special run-off election.
(Mark if applicable)
❑ on J 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 b �Io Signature
(month, day, year) U (Candidate) FPPC Form 501 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov