HomeMy WebLinkAboutForm 410- Andrew McCullough for City Council 2015 Initial•1117% n CANDIDATE INTENTION STATEMENT
Candidate Intention Statement Type or Print in Ink. . -
Check One: ❑X Initial ❑Amendment (Explain)
1. Candidate Information:
MAY 18 2015 For Official Use
Time:
City Clark's Office
NAME OF CANDIDATE (Last, First. Midde Initia:) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional; E-MAIL (optional)
McCullough, Andrew, C. (
STREET ADDRESS CITY STATE ZIP CODE
San Rafael CA 94901
OFFICE SOUGHT (POSITION TITLE) AGENCY NAME DISTRICT NUMBER, if appl'cable. 9 NON-PARTISAN
Councilmember San Rafael City Council PARTY -
OFFICE JURISDICTION
❑ State (Complete Part 2.)
2015
® City ❑ County ❑ Multi -County: (Name of Multi -County Jurisdiction) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(CalPERS and Ca1STRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(Year o/ 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:
O 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 ff applicable)
❑ on —J 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 alifornia that the foregoing is true and correct.
Executed on �( fr//S Signature
(month, day, year) (Candidate) FPPC Form 501 (April/2011)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)