HomeMy WebLinkAboutForm 501- Rachel Kertz for Board of Education 2018 InitialCandidate Intention Statement
Check One: Z Initial []Amendment (Explain)
. Candidate Information:
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Date Stamp
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CITY CLERK'S OFFICE
NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E-MAIL (optional)
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STREET ADDRESS CITY STATE ZIP CODE
OFFICE SOUGHT
(POSITION TITLE) AGENCY NAME DISTRICT NUMBER, If applicable. II NON-PARTISAN
2USTC�G $,WV 6W W Eli L clrY PARTY:
OFFICE JURISDICTION
❑ State (Complete Part 2.)
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City ❑ County ❑ Multi -County: (Name of Multi -County Jurisdiction) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(CaIPERS and Ca1STRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(Year of Election)
Primary/general election (Year o/ 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: I and I accept the voluntary expenditure ceiling for
the general or special run-off election.
(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 40 A // s ,,
Signature �'�-f.�K-F'
(month, day, year) (CandidaTej FPPC Form 501 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov