CA Form 501 Candidate Intention Statement - Susan BrooksCanate Intention Statement
Check One: ' ial ❑ Amendment (Explain)
1. Candidate Information:
NAME OF CANDIDATE (Last, First, Middle Initial)
STREET ADDRESS
Type or Is in Ink.
DAYTIME TELEPHONE NUMBER
(
CITY
WY W RANCHO PALOS VE
'JUL 13 2015
S
CANDIDATE INTEII11111111111115TATEMENT
For Official Use
FAX NUMBER (optional) E-MAIL (optional)
t )
STATE ZIP CODE
OFFICE SOUG (POSITION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable. ON -PARTISAN
/C� - � C % C� PARTY:
OFFICE JURISDICTION
❑ State (Complete Part 2.)
it ❑ y Count ❑ Multi -County: ty• '( e of Multi -County Jurisdiction) (Ye r of Election)
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.
❑ 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:
the general or special run-off election.
and I accept the voluntary expenditure ceiling for
(Mark if applicable)
❑ On _I__-_/ , 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 l S 9
Si nature
( th, day, year) (Ca4rtdate)
FPPC Form 501 (April/2011)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)