HomeMy WebLinkAbout501 - 08/11/2022_ Redacted (TJH)Candidate Intention Statement
Check One: Onitial ❑Amendment (Explain)
1. Candidate Information:
NAME OF CANDIDATE (Last, First Middle Initial)
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STREETADDRE S
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DAYTIME TELEPHONE NUMBER
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CITY
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For Official Use Only
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FAX NUMBER (optional) EMAIL (optional)
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STATE ZIP CODE
OFFICE JURISDICTION 1 r l�.necrt one oox, if appllum
❑ State (Complete Part 2.) ) PRIMARY / GENERAL
City ❑ County ❑ Multi -County: (Name of Multi County Jurisdiction) (Year f Election) ❑ SPECIAL / RUNOFF
2. State Candidate Expenditure Limit Statement:
(CaIPERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(Check one box)
❑ I accept the voluntary expenditure ceiling for the election stated above.
❑ 1 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 / / and I accept the voluntary expenditure
ceiling for the general or special run-off election.
(Mark if applicable)
❑ On, II 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
( onth, day, year) (Candidate)
FPPC Form 501 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov