RAY RUSSOM, CAREN - FORM 501 - CANDIDATE INTENTION STATEMENT Candidate Intention Statement RE 'P CALIFORNIA 501.
FORM
Check One: ®Initial ❑Amendment (Explain)
MAY 2 3 2022 For Official Use Only
• CTTY CLERK'S OFFICE
CITY OF ARROYO GRANDE
1. Candidate Information:
NAME OF CANDIDATE (Last,First Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER(optional) EMAIL(optional)
Caren Ray Russom (805 ) ( )
STREET ADDRESS CITY STATE ZIP CODE
Arroyo Grande CA 93420
OFFICE SOUGHT(POSITION TITLE) AGENCY NAME DISTRICT NUMBER,if applicable.®NON-PARTISAN OFFICE
Mayor City of Arroyo Grande PARTY PREFERENCE:
OFFICE JURISDICTION (Check one box,if applicable.)
0 State (Complete Part 2.) 2022 ® PRIMARY/GENERAL
®City County ❑ Multi-County: (Name of Multi-County Jurisdiction) (Year of Election) ❑ SPECIAL/RUNOFF
2. State Candidate Expenditure Limit Statement:
(CaIPERS and CaISTRS candidates,judges,judicial candidates,and candidates for local offices do not complete Part 2.)
(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:
0 I 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, / L 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/t51 alifdrnia he foregoing is true and correct.
5 24 2022 ---
Executed on Signature
(month,day,year) Candidate)
FPPC Form 501 (August/2018)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov