Form 501 06-17-22Candidate intention Statement
Check One: Initial ❑Amendment (Explain)
Date Stamp
city OF E CINITAS
City CLERK
2022 JUN 17 PH 1* 33
For Official Use Only
1. Candidate Information:
ME OF CANDIDATE (rase, Fi ddle infHa)
DAYTIME TELEPHONE NUMBER
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FAX NUMBER (optional) EMAIL (optiorfal)
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ST�R-rEETADDRESS
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CITY g
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STATE ZIPCCCEE
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OFFICE SOUGHT (POSIITIO^N�, TITLE)
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AGENCY NAME
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DISTRICT NUMBER, if appli=[]NON-PARTISAN
OFFICE
EFERENCE:
lt„.. 6„4A4 II .14
OFFICE JURISDICTION
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(Check one box, if applicable.)
"o' RIMARY iGENERAL
❑ State (complete Part 2.)
Slaty ❑ County Mufti -County:
❑
Y of Election) ❑ SPECIAL I RUNOFF
dstlidion)
(Name of Multi -County Jurisdiction)
2. State Candidate Expenditure Limit Statement:
(CalFERS and CalSTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(Check one box)
❑ 1 accept the voluntary expenditure ceiling for the election stated above.
17711 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 _f / and 1 accept the voluntary expenditure
ceiling for the general or special run-off election.
(Mark if 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 S alifornia that the foregoing is true and correct.
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Executed on "�- ' `"� � ✓ Signature I �,,�s� �i f
(month, day, year) (Candidata) FPPC Form 501 (AugusV2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov