Form 501 - Candidate Intention Statement 2016 CANDIDATE INTENTION STATEMENT
Candidate Intention Statement Type or Print in Ink. ,„_, CALIFORNIA
Gi�"',' r ' • '
Check One: ®Initial ❑Amendment (Explain) 2015 OCT 12 P11,116: 03 For Official Use Only
1. Candidate Information:
NAME OF CANDIDATE (Last,First,Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER(optional) E-MAIL(optional)
Boerner Horvath,Tasha N ( 760 )274-4905 tasha4encinitas @gmail.com
Encinitas CA 92024
OFFICE SOUGHT(POSITION TITLE) AGENCY NAME DISTRICT NUMBER,if applicable. ®NON-PARTISAN
City Council City of Encinitas PARTY
OFFICE JURISDICTION
❑State (Complete Part 2.)
2016
®City ❑County ❑ 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.)
(Year o/Elec Primary/general election Special/runoff election
tron) (Year of 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 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 al' n' th t the a in true and correct.
Executed on '�I�"7 �i Signature
(month,day,year) (Ca ldate) FPPC Form 501(April/2011)
FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772)