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Recipient Committee
Date Stamp
CALIFORNIA
FORM
41 0
Statement Type Ill Initial 0 Amendment 0 Termination- See Part 5 of Carmel-by-t e eaa
e Not yet qualified
or JUN -4 2018
0 Date qualified as committee I /.
Date qualified as committee
'---'·
Date of termination
CHARDY824@GMAIL.COM
COUNTY OF DOMICILE JURISDICTION WHERE COMMinEE IS ACTIVE NAME Of PRINCIPAL OFFICER(S)
penalty of perjury under the laws of the State of California that the foregoim
Executed on JUNE 4, 2018 By _ _ _ _ _ __
~~TE
Executed on
JUNE 4, 2018 By
DATE
Executed on By
DATE
Executed on By
DATE SIGNA11JRE OF CONTROLliNG OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov {866/275~3772)
www.fppc.ca.gov
City of Carmel-by-the-Sea
COMMITTEE NAME
Received by City Clerk
.
J.D. NUMBER
• All committees must list the financial institution where the campaign bank account is located.
• List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and
district number, if any, and the year of the election.
• List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." Stating "No party preference" is acceptable.
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
Nonpartisan Partisan (list political party below)
L 0 0
Pnman/y Formed Commtttee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE($) NAME OR MEASURE(S) FULL TITLE (INCLUOE BALLOT NO. OR LETTER) CANDIDATE($) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
,- - - - - I'BT lo
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
I _loRT loo
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275·3772}
www.fppc.ca.gov
Candidate Intention Statement
of ~~rffl~-by-t C~'\UI=ORNIA
t=URM
50 1
Check One: ~Initial 0Amendment (Explain)---------------
JUN -4 2018 For Official Use Only
1. Candidate Information:
NAME OF CANDIDATE (Last, First, Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER (optional) E-MAIL (optional)
D I accept the voluntary expenditure ceiling for the election stated above.
D 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)
D 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 and correct.