Form 501 Candidate Intention Statement
Check One
1. Cand
®Initial ❑Amendment (Explain)
NAME OF CANDIDATE (Last.First,Middle Initial)
Forrester, Kevin K
STREET ADDRESS
4403 Manchester Ave Ste 205
OFFICE SOUGHT(POSITION TITLE) AGENCY NAME
City Council Member City of Encinitas
... uvv�✓�V .WIN
❑ State (Complete Part 2)
Type or Print in Ink.
DAYTIME TELEPHONE NUMBER
f 760 944-1918
CITY
Encinitas
INTENTION
Date Stamp
:IT Y OF ENCINITA S For Official Use
CITY CI-ERR
12 AUG -8 Aid 11: 1
FAX NUMBER(optional) E-MAIL(optional)
S IAl t ZIP COE
CA 92024
® City ❑ County ❑ Multi-County 2012
(Name of Multi-County Jurisdiction) (Year of Election)
2. State Candidate Expenditure Limit Statement:
(CalPERS and CaISTRS candidates,judges,judicial candidates, and candidates for local offices do not complete Part 2.)
(Year of E/ect�on)
Primary/general election Special/runoff election
(Year of Election)
(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.
IN NON-PARTISAN
PARTY
Amendment:
O 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—J , I contributed personal funds in excess of the expenditure ceiling for the election stated above
3. Verification:
certify under penalty of perjury under the laws of the State of Californ' th t the foregoing is true and correct.
Executed on 9/ ��%� Signature
(mont`, day,year) (Candidate)
FPPC Form 501 (April/2011)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)