HomeMy WebLinkAboutOrcutt - Form 501 - 2022-07-18_RedactedCandidate Intention Statement CALIFORNIA 501
FORM
Check One: O~I 0Amendment (Explain) --------------;---
For Official Use Only
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1. Candidate Information:
DA'(JIME TELEPHONE NUM BER
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FAX NUMBER (optional) EMAIL (optional)
CITY STATE ZIP CODE
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AGENCY NAME DISTRICT NUMBER. if appl ica ble.lP'tNON -PARTISAN OFFICE
CE :
OFFICE JURISDICTION
O State (Complete Part 2.)
~City O County ~D~~
(Year ol Election) O Multi-County: (Name of Multi-County Jurisdiction) D SPECIAL I RUNOFF
2. State Candidate Expenditure Limit Statement:
(Ca/PERS and Ca/STRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2-)
(Check one box) ~ accept the voluntary expenditure ceiling for the election stated above.
O I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
O I 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)
O 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 fore
Executed on 7-J S?-O(_ a -i Q Signature
(month. day, year) ~'\ (Csno'i(fate) FPPC Form 501 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov