CA Form 501 Candidate Intention Statement - Benjamin K. Kelly 1116 a
Candidate Intention Statement
Bate tamp_ CALIFORNIA 501
CITY Of RANCHO PALOS VER FORM
JUN 0 1 2017 For Official Use Only
Check One: El Initial 0 Amendment (Explain)
orry MEW'S OFFICE
1. Candidate Information:
NAME OF CANDIDATE (Last,First,Middle initial) DAYTIME TELEPHONE NUMBER FAX NUMBER(optional) E-MAIL(optional)
Kelly, Benjamin K. ( 310 ) 9404152
STREET ADDRESS CITY STATE ZIP CODE
Rancho Palos Verdes CA 90275
OFFICE SOUGHT(POSITION TITLE) AGENCY NAME DISTRICT NUMBER,if applicable. rgic NON-PARTISAN
Councilmember City of Rancho Palos Verdes N/A PARTY:
OFFICE JURISDICTION
0 State (Complete Part 2.)
2017
El City El County EJ Multi-County: (Name of Multi-County Jurisdiction) 5 (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.)
Primary/general election Special/runoff election
(Year of Election) (Year of Election)
(Check one box)
o I accept the voluntary expenditure ceiling for the election stated above.
o I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
0 I 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.
114-16.
(Mark if applicable)
El On , 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 the foregoing is true and correct.
Executed on 5/26/2017 Signature
(month,day,year) (Candidate) FPPC Form 501 (Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov