HomeMy WebLinkAbout2018.06.01_Addis_Dawn_Form 501Candidate Intention Statement
Check One: (jnitial ['Amendment (Explain)
JUN 1 2018
1. Candidate Information:
NAME OF CANDIDATE (Last, First, Middle Initial)
DAYTIME FAX NUMBER (optional) E-MAIL (optional)
Ni3S �, � 9 )uri , (�( )
STREET ADDRESS t CITY STATE ZIP CODE
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CY NA E [DISTRICT NUMBER, if applicable. 1Z1 NON -PARTISAN
l�01 ▪ I 1A A 4 1 / 'M Y DLL�/ �V 431"OV ° fPPARTY:
OFFICE JJURISDICTION
O State (Complete Part 2.)
pQ///City Cl County 0 Multi -County. (Name of Multi -County Jurisdiction)
Cfty'IerK
(Year o Elect n)
2. State Candidate Expenditure Limit Statement:
(CaIPERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
Primary/general election
(Year of Election)
Special/runoff election
(Year of 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:
0 1 did not exceed the expenditure ceiling in the primary or special election held on- _1—J and I accept the voluntary expenditure ceiling for
the general or special run-off election.
(Mark if applicable)
❑ On —J—J , I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification:
1 certify under penalty of perjury under the laws of the Si
Executed on 01C`? Signature
(month, day, year)
orrect.
FPPC Form 501 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov