CA Form 501 Candidate Intention Statement - Jerry DuhovicCanate Intention Statement
Check One: r1itial ❑ Amendment (Explain)
Type or 0 in Ink.
RMEIVED
OF RANCHO PgL05
JUL 16 2015
CANDIDATE I
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1. Candidate Information:
NAME OF CANDIDATE„ (Last, First, i itial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E-MAIL (optional)
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STREET ADDRESS CITY
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OFFICE SOUGHT (PO TION TITLE) A NCY ME D
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OFFICE JURISDICTION
❑ State (Complete Part 2.)
?'Wity❑ Count Multi-Coun y `7 (Name of Multi -County Jurisdiction)
For Official Use Only
ATE ZIP COD
4-- §000"�
UMBER, if applicable. N -PARTISAN
PARTY:
002.0 [ (��
(Year of Election)
ATEMENT
2. State Candidate Expenditure Limit Statement:
(Ca/PERS and Ca/STRS 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.
❑ 1 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: _J -I 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
true and correct.
I*
FPPC Form 501 (April/2011)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)
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