HomeMy WebLinkAboutForm 501 - Maribeth BusheyCandidate Intention Statement
Check One: nitial ❑Amendment (Explain)
1. Candidate Information:
N F CANDIDATE (Last, First Middle Inilkal)
STR TADDRESS
'
OFF CSOt]GHT (POSITION TITLE) AGEN Y
G� PW&40
OFFICE JURISDICTION
❑ State (Complete Part 2 )
TELEPHONE NUMBER
-
6_-�A -e-/
D[E
�AUG - 3 2022
-=CLERKYS OFFICE
FAX NUMBER (optional) EMAIL (optional)
STATE ZIP CODE
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For Official Use Only
OFFICE
PREFERENCE -
(Check one box, if appl:;.ahlc )
dZ� � �� [C�.DRtll7)ARY / GENERAL
«y E3 County E] 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)
❑ 1 accept the voluntary expenditure ceiling for the election stated above.
❑ I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
Q 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, _/_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 theState of California that the foregoing is true and correct.
Executed on `
FPPC Form 501 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov