Form 501 08-08-2022Candidate Intention Statement
Check One: 0 Initial ❑ Amendment (Explain)
1. Candidate Information:
NAME OF CANDIDATE (L st, First Middle In
T (' I ►J
Date Stamp
CITY OF ENCINIT
CITY CLERK
2022 AUG -8 PM 2:
DAYTIME FAX NUMBER (optional) EMAIL (optional)
For Official Use Only
STREETADDRESS
OFFICE SOUGHT (POSITION TI LE AGENCY NAME j DISTRICT NUM ER, if applicable. NON -PARTISAN OFFICE
I1 1 I Ml b . _ ��� PARTY PREFERENCE:
OFFICE JURISDICTION (Check one box, if applicable.)
❑ State (Complete Part 2.) t }' } PRIMARY / GENERAL
City ❑ County ❑ Multi -County: (Name of Multi -County Jurisdiction) (Year of Election) ❑ SPECIAL / RUNOFF
2. State Candidate Expenditure Limit Statement:
(CalPERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.)
(Check one box)
accept the voluntary expenditure ceiling for the election stated above.
❑ I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment:
p 1 did not exceed the expenditure ceiling in the primary or special election held on: _/—J 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.
Y � Signature � `'
Executed on , FPPC Form 501 (August/201E)
( onth, day, year) (Candidate)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov