Form 501 08-15-22Candidate Intention Statement
Check One: Initial [I Amendment (Explain)
1. Candidate Information:
Date Stamp
CITY OF IrNCINI
CITY CLERK
2022 AUG 15 AM 10:I4 9
For Official Use Only
NAME
7F CANDIDATE (Las first Middle Initial) FAX NUMBER (optional) EMAIL (optional)
ST EETADDRES CITY I STATE ZIP CODE
OFFICE SOUG (POSITION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable. NON -PARTISAN OFFICE
.VA YD PARTY PREF RENCE:
OFFICE U SDICTION WPRI
K one oox, 1T app icaoie.)
State (Complete Part 2.) 0 MARY/ GENERAL
City ❑ County ❑ Multi -County: (Name of Multi -County Jurisdiction) (Year of Election) ❑ SPECIAL / RUNOFF
2. State Candidate Expenditure Limit Statement:
(CalPERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(Check one box)
17711 accept the voluntary expenditure ceiling for the election stated above.
❑ I 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: _/—J 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
j�under the laws of the Sta ff Californi t the egoing is true and correct.
!9/ Executed on /�`J " Signatur '
(month, day, year) (C didate) FPPC Form 501 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/2753772)
www.fppc.ca.gov