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HomeMy WebLinkAboutForm 501 - Maika Llorens Gulati for City Council 2020L5 Candidate Intention Statement I Check One: ®Initial ❑Amendment (Explain) F — 2020 q1EF.rW0ffla.IU..Oly 1. Candidate Information: NAME OF CANDIDATE (Lest, First Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) EMAIL (optional) Gulati, Maika Llorens ( ( ) STREETADDRESS CITY STATE ZIP CODE San Rafael CA 94901 OFFICE SOUGHT (POSITION TITLE) AGENCY NAME DISTRICT NUMBER, If applicable. Q NON-PARTISAN OFFICE Councilmember City of San Rafael 1 1 1 PARTY PREFERENCE: OFFICE JURISDICTION ❑ State (Complete Part 2.) ® City ❑ County ❑ Multi -County: (Name of Mulb-County Jurisdiction) 2. State Candidate Expenditure Limit Statement: (Ca1PERS and Ca1STRS 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. (Check one box, if applicable.) 2020 © PRIMARY/ GENERAL (Year of Election) ❑ SPECIAL/ RUNOFF Amendment: 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 opplicable) ❑ On _/_/ 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 th f egoing I true and correct. Executed on February 4, 2020 Signature (month, day, year) (Candidate) FPPC Form 501 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov