HomeMy WebLinkAbout2021-11-08 Form 501 - HarnikCi I Y CLB ?" ll ICE
Candidate Intention Statement
Check One: m Initial ❑ Amendment (Explain)
1. Candidate Information:
NAME OF CANDIDATE (Last, First Middle Initial)
Date StampJ'�t(�/
'Y
21 OV -8 AM 9: 18
DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) EMAIL (optional)
Hamill, Jan C ( ( )
STREETADDRESS CITY STATE ZIP CODE
For Official Use
Palm Desert CA 92260
OFFICE SOUGHT (POSITION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable. ® NON -PARTISAN OFFICE
Council City of Palm Desert 2 PARTY PREFERENCE:
OFFICE JURISDICTION (Check one box, if applicable.)
❑State (Complete Part 2.) 2022 ® PRIMARY/ GENERAL
m city ❑ County ❑ Mult-Courty (Name of Mudi-County Jurisdiction) (Year of Election) ❑ SPECIAL / RUNOFF
2. State Candidate Expenditure Limit Statement:
(CaIPERS 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.
❑ 1 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 _/_/ and I accept the voluntary expenditure
ceiling for the general or special run-off election.
(Mar, f applicable)
❑ On, __1___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 f Calffomia that the foregoing is true and correct.
Nov 08 2021
F�scuted on Signature
(mcm, day, year) ( FPPC Form 501 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov