Form 501 03/01/22 Candidate Intention Statement °atestam? •' '
CIT Y .Of`.ENCINIT b S' For Official use Only
Check One: /initial f'1•Y ' ��
❑Amendment (Expla;n)
2022 M kR—1. PM 3= 50
1. Candidate Information: 3 �
NAME OF CANDIDATE (Last,First Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER(optional) EMAIL(optional) A�C
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OFFICE SOUGHT(POSITION TITLE) AGENCY NAME DISTRICT NUMBER,if applicable. ON-PARTISAN OFFICE
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611 C i T D C— PARTY PREFERENCE:
OFFICE JURISDICTION (Check one box,if applicable.)
❑State (Complete Part 2.) �/� 7— ❑ PRIMARY/GENERAL
City ❑ County ❑ Multi-County: (Name of Multi-County Jurisdiction) (Year of 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 expendituri ceiling for the election stated above.
❑I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
Q 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 _J_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 California that the foregoing is true and correct.
Executed on Signature
( Dorn,day,year) (Candidate) FPPC Form 501 (August/2018)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov