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HomeMy WebLinkAbout2022-05-17 - Form 501 - JacksonCandidate intention Statement p. CALIFORNIA501 FORM Check One: .I - F©r Official use only nitial ❑Amendment (Explain) µ 1. Candidate Irnrormation. ME O CANDIDATE Las, FwstMiddle WN DAYTIMETE TELEPHONE NUMBER FAX MWOR � E il!" I NA F i S � _ ) i 9L Vd ri STREET ADDRESS _ CITY STATE {.. g: e� . " 1?' QE i �riifC- r0-1 ..�,7 OFFICE SOUGHT (POSITION TITLE) AGENCY NAME ISTRICT NUMBER, if applicable, FPAARRT)Y ON-PARTISAN! ONCE �F� � � / ` V' a� F ,.II I 'm+' �' ■ `� PREFERI*-NC' .E. �4 OFFICE JU ISDICTION (Check one box, if applicable-) ❑ State (CmPleie hart ) ❑ PRIMARY. I GENERAL City Courtly Mulf�..ourity: SPECIAL! RUNOFF ❑ ❑ (Nance of Mufti-ODunty Jurisdiction) tYear ) ❑ 2. State Candidate Expenditure Limit Statement: (CalPERS and CaIS TRS candidates, judges, judicial candidates, and candidates fc+r local dFces do not complete Part 2.) (Check one box) ❑ 1 accept the voluntary expenditure ceiling for the election stated above. ❑ 1 do not accept the voluntary expenditure ceiling for the election stated above_ Amendment: r 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, _Ja.�� 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 corrects r mar - Executed on � �-� ��` agnab.ere gJ4 FPPC Form 501 (August/2018) FPPC Advice: adviiceLfppc,ca.gov (866/275-3772) www.fppc.6a.gov 0