HomeMy WebLinkAboutForm 501- Greg Brockbank for City Council 2013I rtl fF� e4l Okr4l Wo
Check One: Eil Initial []Amendment (Explain)
Type or Print in Ink. Date Stamp
CALIFORNIA 001
FORM
For Official Use Only
1. cancimate information:
NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E-MAIL (optional)
K.
STREET ADDRESS CITY STATE ZIP CODE
OFFICE SOUGHT (POSITION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable. NON-PARTISAN
A
Cci � k0 cl -L ", 'V_ r, e- - C' -FPARTY:
OFFICE JURISDICTION
® state (Complete Part 2.)
El City [I County El 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) Primatylgeneral election (Year of Election) speciallrunoff election
(Check one box)
E] 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: and I accept the voluntary expenditure ceiling for
the general or special run-off election.
(Mark if applicable)
0 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 of California that the foregoing is true and correct.
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Executed on k I --I Signature
(month, day year) (Candidate) FPIPC Form 601 Apr l/2011
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)