HomeMy WebLinkAboutForm 501 - Jon H. BlackCandidate Intention Statement
Check One: 0jtial []Amendment
(Explain)
1. Candidate Information:
Only
NAME OF CANDIDATE (Last, Fist Middle Initial) DAYTIME T,,LEPHONE NUMBER FAX NUMBE}l (optio,,Itil) EP4AIL (optIonal)
Black, Ton H, (
STREETADDRESS CITY STAT_EZIP CODE
San Rafael CA 941903
OFFICE SOUGHT (POSITION TITLE) AGE CY NAME ISTRICT NU,,-. ER, ifipplica,pQ. N - OWPARTEA_IJ OFF,CE
CoLincilmember - District 4/Northern City of Sail, Rafael 4 PAPZTY Pyltz-FEREaNCE:
OFFICE JURISDICTION
❑ State (Complete Part 2.) 2024 PRIMARY t Q�NERXL
City F1 County E] Multi -County: (Name of Mufti -County urisdictlon) SPECIAL R,UNOFF
2. State Candidate Expenditure Limit Statement'
(CalPERS and CaISTRS candidates, judges, judicial candidates, and candidateg for local offices do not oompleta Part 2.)
(Check one box)
171 accept the voluntary expenditure ceiling for the election stated above.
M I do not accept the voluntary expenditure ceiling for the election stated Qbove,
Amendment:
0 1 did not exceed the expenditure miflinq in the primary or special election, held on and M accept the voluntary experlditwre
ing for the general or special run-off election,
(Mark if applicable)
M 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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FP?C Form, 501 44AugustfZ0231
FPPC Advice: a0,%4ce@,Fwc.c0,pv (096/275-37721
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