Form 501 Candidate Intention Statement ,r.
Candidate Intention Statement
Check One: L!Initial ❑Amendment (Explain)
Type or Print in Ink.
Date Stamp
CITY OF ENCINITA
CITY CLEF;;
014 AUG -8 Pik 5: 0
CANDIDATE
'I. candidate Intormatlon:
NAME OF CANDIDATE (Last,First,Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER(optional) E-MAIL(optional)
i3AwAAt y MuAiftW-99— ( M�kE> L , (?6y) 8/5' 63yy ( VvJb'uz a""!y e shC86)A4, n-el
STREET ADDRESS /1n f1
OFFICE SOUGHT(POSITION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable. NON-PARTISAN
v� NcA.Vi7--,JS MA Vof� .
PARTY:
OFFICE JURISDICTION
❑ State (Complete Part 2.)
City El County ❑ Multi-County: (Name of Multi-County Jurisdiction) (Year of Election)
2. State Candidate Expenditure Limit Statement: AIIA .
(CalPERS and CalSTRS candidates,judges,judicial candidates, and candidates for local offices do not complete Part 2.)
(Year of Election)
Primary (Year of Election)
/general election Special/runoff election
(Check one box)
❑ I accept the voluntary expenditure ceiling for the election stated above.
❑I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
O 1 did not exceed the expenditure ceiling in the primary or special election held on: 1_l and I accept the voluntary expenditure ceiling for
the general or special run-off election.
(Mark if applicable)
❑ 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 the foregoing is true and correct.
Executed on ATVs F 7 -�201 V Signature 1;1�-
w/
(month,day,year) (Candidate)
FPPC Form 501 (April/2011)
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