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501 Candidate Intention Statement
Candidate Intention Statement Check One: ® Initial ❑Amendment (Explain) on: Type or Print in Ink. Date Stamp STATEMENT NAME OF CANDIDATE (Lest, First, Middle Initial) devinel03@road runner, corn STREET ADDRESS CITY STATE ZIP CODE SEAL BEACH CA 90740 OFFICE SOUGHT (POSITION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable. © NON-PARTISAN CITY CLERK CITY OF SEAL BEACH N/A PARTY: ❑ State (Complete Part 2.) ® City ❑ County ❑ Multi -County: (Name ofMulti-County Jurisdiction) (Year of Election) 2. State Candidate Expenditure Limit Statement: (CaIPERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.) (Year of action) (year of Election) Primary/general election Speclal/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: _j—J and I accept the voluntary expenditure ceiling for the general or special run-off election. (Mark it 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 FPPC Form 501 (April/2011) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)