Form 501 Candidate Statement Candidate Intention Statement
Check One: [Initial ❑Amendment (Explain)
Type or Print in Ink.
Date Stamp
CIT OF ENCINITAc,
ITY Ct ERK
2014 AUG -8 P11 5: 36
CANDIDATE INTENTION
NAME OF CANDIDATE (Last,First,Middle Initial) \ DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E-MAIL(optional)
STREET
AGENCY NAME DISTRICT NUMBER,if applicablFPARTY ARTISAN
(%
OFFICE JURISDICTION
❑ State (Complete Part 2.)
5'Clty ❑ County ❑ Multi-County: (Name of Multi-County Jurisdiction) (Year oof action)
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)
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: I 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 Signature ats.L
(month,day,yeai) (Candidate)
FPPC Form 501 (April/2011)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)