Fillable Form For Each Elecon, Including Reelecon To The: (CITY OF LA HABRA)

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Form For Each Elecon, Including Reelecon To The: (CITY OF LA HABRA)

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FPPC Form 501 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Candidate Intention Statement
501
CALIFORNIA
FORM
Who Files:
A candidate for state or local oce must le this
form for each elecon, including reelecon to the
same oce. Excepon: Candidates for county central
commiee that do not raise or spend $2,000 or more
in a calendar year are not required to le a Form 501.
When to File:
File the Form 501 before you solicit or receive any
contribuons or before you make expenditures from
personal funds on behalf of your candidacy. This form
is considered led the date it is postmarked or hand
delivered.
Ensure campaign deadlines are met. Go to
www.fppc.ca.gov for most campaign disclosure ling
schedules or check with your local ling ocer.
Where to File:
State Candidates (including Judges):
Secretary of State
Polical Reform Division
1500 11th Street, Room 495
Sacramento, CA 95814
Phone (916) 653-6224
www.sos.ca.gov
Local Candidates:
Generally your county elecon oce or city clerk.
Electronic ling may be required.
Bank Account:
A separate campaign bank account must be
established including for campaigns that are
self-funded by the candidate. A bank account is
not required if a candidate will not receive any
contribuons or make personal expenditures of
less than $2,000 in a calendar year. The ling and
statement of qualicaon fees are not included in
calculang the $2,000.
How to Complete:
All candidates: Complete Parts 1 and 3.
Candidates for elecve state oce: Complete Parts 1,
2, and 3.
Excepon: Candidates for an elecon to the California
Public Employees’ Rerement Board, the State
Teachers’ Rerement Board, judges, and judicial
candidates do not complete Part 2.
Part 1. Candidate Informaon
• Enter your name and street address.
• Enter the tle of the oce sought, agency name,
and district number if any (e.g., City Council
Member, City of Smalltown, Dist. 5).
• Enter your polical party preference if seeking
a parsan oce. For a list of qualied polical
pares, go to: www.sos.ca.gov/elecons/polical-
pares/qualied-polical-pares/.
• Check the appropriate box regarding the oce’s
jurisdicon.
Part 2. Voluntary Expenditure Ceiling
This secon applies to certain candidates for elecve
state oce, including State Senate and Assembly and
statewide oces.
The voluntary expenditure ceiling applicable to your
oce is set forth in FPPC Regulaon 18545. You must
state whether you accept or reject the expenditure
ceiling. Candidates who accept the voluntary
expenditure limit will be designated in either the state
voter informaon guide (statewide candidates) or the
county voter informaon guide (Senate and Assembly
candidates) and may purchase space for a 250-word
statement there.
You may amend the Form 501 to change your
acceptance or rejecon of the voluntary expenditure
ceiling only under the following circumstances:
• Between the date of ling an inial Form 501 for
an elecon and the deadline for ling nominaon
papers for that elecon, you may amend your
statement of acceptance or rejecon of the
voluntary expenditure ceiling no more than two
mes as long as the limit has not been exceeded.
• If you reject the voluntary expenditure ceiling in
the primary or special elecon but do not exceed
the ceiling during that elecon, you may amend the
Form 501 to accept the expenditure ceiling for the
general or special runo elecon and receive all of
the benets accompanying the acceptance of the
expenditure ceiling. The amended Form 501 must
be led within 14 days following the primary or
special elecon.
Personal Funds Nocaon:
You must disclose, if applicable, the date you
contribute personal funds to your own campaign that
exceed the expenditure ceiling. File an amended Form
501 within 24 hours by guaranteed overnight delivery,
personal delivery, or, if applicable, by electronic means.
Part 3. Vericaon
The vericaon is signed under penalty of perjury.
This form was prepared by the Fair Polical Pracces
Commission (FPPC). For detailed informaon on
campaign reporng requirements and the Informaon
Pracces Act of 1977, see the FPPC Campaign
Disclosure Manual for your type of commiee.
FPPC Form 501 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Candidate Intention Statement
1. Candidate Information:
2. State Candidate Expenditure Limit Statement:
3. Verication:
Check One:
Initial
NAME OF CANDIDATE
STREET ADDRESS
OFFICE SOUGHT (POSITION TITLE)
OFFICE JURISDICTION
State (Complete Part 2.)
City
(Check one box)
(Mark if applicable)
County Multi-County:
I accept the voluntary expenditure ceiling for the election stated above.
I do not accept the voluntary expenditure ceiling for the election stated above.
the general or special run-off election.
I did not exceed the expenditure ceiling in the primary or special election held on:
Amendment:
, I contributed personal funds in excess of the expenditure ceiling for the election stated above.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on Signature
On
and I accept the voluntary expenditure ceiling for
(CalPERS and CalSTRS candidates, judges, judicial candidates, and candidates for local ofces do not complete Part 2.)
AGENCY NAME
(Name of Multi-County Jurisdiction)
DAYTIME TELEPHONE NUMBER FAX NUMBER (optional)
DISTRICT NUMBER, if applicable.
NON-PARTISAN OFFICE
(Check one box, if applicable.)
PRIMARY / GENERAL
SPECIAL / RUNOFF
PARTY PREFERENCE:
(Year of Election)
(month, day, year) (Candidate)
EMAIL (optional)
ZIP CODESTATE
CITY
( )
( )
Amendment
(Explain)
(Last, First Middle Initial)
Date Stamp
For Ofcial Use Only
CALIFORNIA
FORM
501
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Form For Each Elecon, Including Reelecon To The: (CITY OF LA HABRA)

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Completed 6 August 2020

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