Hayashida, Carrie - Form 501Candidate Intention Statement
Check One: Alnitial ❑Amendment (Exdam)
AUG 1 11021 r Por�Mcial Uca 011y
NAME OF CANDIDATE (Lee Fiat Nidde WA4FPHQNF
NUMBER
FAX NUMBER(ePllonen
EMAIL tocuorAll
Na Y ASt1 iDA dG CA-RRI I.
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ZIPCODE
STREETADDRESSCITY
ICY
STATE
C!F
10 630
P rzE Ss
OFFIOEaOUONT(POSITON TITLE)
AGENCY NAME
DI STRICT NUMBER. a apWineie.
NON -PAN OFFICE
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co nG va. V� yer
CYPRESS Gry
PARTY PREFERERTISANCE:
OFFICE JURISDICTION
(CNeck One lmp A appll®Ne.
XPRIMARY I GENERAL
❑ SWR ICmokle Pent,l
2
�dC@r DComte Mud -county:
(ror�G ❑SPECLALIRUNOFF
(AM V MUWUounry JUNWichon)
2. State Candidate Expenditure Limit Statement:
(eaIPERSeMCaI5lR5 tdnddafealvtlges. juc5clal caMlaeres, and aanadaresWbaror tlo not mmplee Part i)
(ehedFone box)
0 accept the voluntary expenditure ceiling for the election stated above.
❑I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
0 1 did not exceed the expenditure Ceiling in the primary or special election held on _f 1 and I accept the voluntary expenditure
ceiling for the general or special runoff election.
(Man n apginbie)
❑ 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 Bing is true and correct.
Execu—Z— 2oZ2 ma
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Imwm, day, yq (Ceno'eele) FPPC Form SBI (August/2m8)
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