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Candidate Intention Statement <br />Check One: ❑ Initial <br />1. Candi <br />on: <br />®Amendment (Explain) Amending the form to update the <br />election year to 2019 <br />JAN 2 7 2016 1 For Official Use <br />City of Riverside <br />City Clerk's Office <br />NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E -MAIL (optional) <br />Soubirous, Michael P. I ( ) <br />STREET ADDRESS CITY STATE ZIP CODE <br />Riverside CA <br />OFFICE SOUGHT (POSITION TITLE) AGENCY NAME DISTRICT NUMBER, if applicable. QNON- PARTISAN <br />City Councilman City of Riverside Ward 3 PARTY: <br />OFFICE JURISDICTION <br />❑ State (Complete Part 2.) <br />2019 <br />® City ❑ County ❑ Multi-County: (Name of Multi -County Jurisdiction) (Year of Election) <br />2. State Candidate Expenditure Limit Statement: <br />(CalPERS and CaISTRS candidates, judges, judicial candidates, and candidates for local offices do not complete Part 2.) <br />(Year of Election) <br />Primary/general election (Year of Election) Special /runoff election <br />(Check one box) <br />❑ I accept the voluntary expenditure ceiling for the election stated above. <br />❑ I do not accept the voluntary expenditure ceiling for the election stated above. <br />Amendment: <br />O 1 did not exceed the expenditure ceiling in the primary or special election held on: and I accept the voluntary expenditure ceiling for <br />the general or special run -off election. <br />(Mark if applicable) <br />❑ On I contributed personal funds in excess of the expenditure ceiling for the election stated above. <br />3. Verification: <br />I certify under penalty of perjury under the laws of the St a d correct. <br />Executed on " ( — Z Cs° % 6, Signature <br />(month, day, year) (Candidate) FPPC Form 501 (Jan/2016) <br />FPPC Advice: advice @fppc.ca.gov (866/275 -3772) <br />www.fppc.ca.gov <br />