Candidate Intention Statement CALIFORNIA
FORM 501
Who Files: Exception: Candidates for any election to the State Form 501 to accept the expenditure ceiling for the
A candidate for state or local office must file this Public Employees Retirement Board do not complete general or special runoff election and receive all of
form prior to solicitation or receipt of any Part 2. the benefits accompanying the acceptance of the
contribution, or expenditure of any personal funds expenditure ceiling. The amended Form 501 must
used for the election. Part 1. Candidate Information be filed within 14 days following the primary or
• Enter your name and street address. special election.
You must file a separate Form 501 for each
election, including reelection to the same office. • Enter the title of the office sought, agency name Subsequent Election When Ceiling not
and district number if any (e.g., City Council Exceeded:
Exception: This form is not required if you will not member, City of Smalltown, Dist. 5), and political
solicit or receive contributions from other persons If you reject the voluntary expenditure ceiling in the
party affiliation, if seeking a partisan office.
and the only expenditures will be from your personal primary or special election but do not exceed the
funds used for the filing fee and/or statement of • Check the appropriate box regarding the office’s ceiling, you may accept the expenditure ceiling for
qualifications in the sample ballot or ballot pamphlet. jurisdiction. a subsequent general or special run-off election and
receive all the benefits accompanying such an
Where to File: Part 2. Voluntary Expenditure Ceiling agreement. To do so, you must file an amended
File with the filing officer who will receive your This section applies to certain candidates for Form 501 within 14 days following the primary or
original campaign disclosure statements. elective state offices, including State Senate and special election.
Assembly and statewide offices.
State Candidates: Personal Funds Notification:
The voluntary expenditure ceiling applicable to your
Secretary of State You must disclose, if applicable, the date you
office is set forth in FPPC regulation 18545 and is
Political Reform Division contribute personal funds to your own campaign
published on the FPPC web site (www.fppc.ca.gov).
1500 11th Street, Room 495 that exceed the expenditure ceiling. File an
You must state whether you accept or reject the
Sacramento, CA 95814 amended Form 501 within 24 hours by guaranteed
expenditure ceiling. Candidates who accept the
Local Candidates: voluntary expenditure limit will be designated in either overnight delivery or personal delivery.
Generally your county election office or city clerk. the state ballot pamphlet (statewide candidates) or the
voter information portion of the sample ballot (Senate Part 3. Verification
and Assembly candidates) and may purchase space for Sign and date the form in ink. An unsigned
When to File: statement is not considered filed.
a 250-word statement there.
File the Form 501 before you solicit or receive any
contributions or before you make expenditures from You may amend the Form 501 to change your This form was prepared by the Fair Political Practices
personal funds on behalf of your candidacy. This acceptance of rejection of the voluntary expenditure Commission (FPPC). For detailed information on
form is considered filed the date it is postmarked or ceiling only under the following circumstances: campaign reporting requirements and the Information
hand delivered. • Between the date of filing an initial Form 501 for an Practices Act of 1977, see the FPPC Campaign
election and the deadline for filing nomination Disclosure Manual (available from your filing officer or
How to Complete: papers for that election, you may amend your the FPPC). Campaign filing deadlines, forms, and
All candidates: Complete Parts 1 and 3. statement of acceptance or rejection of the voluntary other informational materials are available on the
expenditure ceiling no more than two times. FPPC website (www.fppc.ca.gov).
Candidates for elective state office: Complete Parts
1, 2, and 3. • If you reject the voluntary expenditure ceiling in the
primary or special election but do not exceed the
ceiling during that election, you may amend the
FPPC Form 501 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
CANDIDATE INTENTION STATEMENT
Candidate Intention Statement Type or Print in Ink. Date Stamp
CALIFORNIA
FORM 501
For Official Use Only
Check One: Initial Amendment (Explain)
1. Candidate Information:
NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E-MAIL (optional)
( ) ( )
STREET ADDRESS CITY STATE ZIP CODE
OFFICE SOUGHT (POSITION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable. NON-PARTISAN
PARTY:
OFFICE JURISDICTION
State (Complete Part 2.)
City County Multi-County:
(Name of Multi-County Jurisdiction) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(CalPERS candidates, judges, judicial candidates, and candidates for local offices are not required to complete Part 2.)
Primary/general election Special/runoff election
(Year of Election) (Year of 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:
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.
(Mark if applicable)
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.
Executed on , Signature
(month, day, year) (Candidate)
FPPC Form 501 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
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