Form 501 Candidate Intention Statement
Check One: Initial ❑Amendment (Explain)
1. Candidate Information:
N O^CA (LaFrst,Middle q� M a RL. - Yv t-r
STREET ADDRESS ; �r - r CITY STATE ZIP WIDE
Type or Print in Ink. Dace Stamp
CI Y OF ENCINI i At-,
CIi Y U^- _R1,"
2011 AUG -9 Wilt Li: 52
CANDIDATE INTENTION STATEMENT
For Official Use Only
DAYTIME TELEPHONE NUM�R n 9 FAX NUMBER(optional) E-MAIL(opbona l n TNO Q.(710 7/ 7" _✓�j c b 1kbcc R�/
OFFICE SOUGHT(POSITION T
A5'^i c- /-1 I ro
OFFICE JURISDICTION
❑ State (Complete Part 2)
&City ❑ County
AGENCY NAME
c ry Covlocu-
dAO .ZD I3.--
�A! b ► 060 Ca v� ','0 I a
❑ Multi-County, (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)
(Near of Election) (Near of Election)Primary/general election Special/runoff election
(Check one box)
❑ I accept the voluntary expenditure ceiling for the election stated above
NON-PARTISAN
PARTY
❑ 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. and I accept the voluntary expenditure ceiling for
the general or special run-off election
(Mark if applicable)
❑ 0n 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 the foregoing is true and correct.
Q u6us-r ') �ibl.Z.•
Executed on Signature
(month,day,year) (Candidate)
FPPC Form 501 (April/2011)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)