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Form 460- Police Association PAC (2016-05-21)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Statement covers period from 01/01/2016 through _..:0:.:5:J./.=2:.:1C.!../..=2..=O.:::1.:::6 ___ _ 1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4. 3. o Officeholder, Candidate Controlled Committee o State Candidate Election Committee o Recall (Also Complele Pari 5) [jJ General Purpose Committee ® Sponsored o Small Contributor Committee o Political Party/Central Committee o Primarily Formed Ballot Measure Committee o Controlled o Sponsored (Also Comp/ele Pari 6) o Primarily Formed Candidate/ Officeholder Committee (Also Complele Pari 7) San Rafael Police Association Political Action Committee STREET ADDRESS (NO P.O. BOX) 1520 Fifth Avenue CITY STATE ZIP CODE San Rafael CA 94901 MAILING ADDRESS (IF DIFFERENT) NO . AND STREET OR P.O. BOX P .O . Box 151557 CITY San Rafael OPTIONAL : FAX / E-MAIL ADDRESS STATE CA ZIP CODE 94915-1557 AREA CODE/PHONE (415)485-3000 AREA CODE/PHONE 4. Verification Date of election if appIi1~at'le: (Month, Day, Year) I;vl'iii=:n-;;;n-;~~-;J.~::J~~;===..:'::'..:;~::::==-l 06/07/2016 2. Type of Statement: 00 Preelection Statement o Semi-annual Statement o Termination Statement (Also file a Form 410 Termination) o Amendment (Explain below) Treasurer(s) NAME OF TREASURER Ms . Beth Minka MAILING ADDRESS 1520 Fifth Avenue CITY San Rafael NAME OF ASSISTANT TREASURER. IF ANY MS . Stacy E. Owens MAILING ADDRESS 5940 College Avenue CITY Oakland OPTIONAL: FAX / E-MAIL ADDRESS STATE CA STATE CA o Quarterly Statement o Special Odd-Year Report o Supplemental Preelection Statement -Attach Form 495 ZIP CODE 94901 ZIP CODE 94618 AREA CODE/PHONE (415)485-3000 AREA CODE/PHONE (510)652-1000 I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowl under penalty of perjury under the laws of the State of California that the foregoing is true and correct. • ed herein and in the attached schedules is true and complete. I certify Executed on ___ o_5...;/'-2_6....;/;:;:2:;:0:-1-6------ Date Executed on ___ 0.::.;5:;.;/:..;2;;.;6:..:/,,;2;,;0;..;1;..;6~ ____ _ Date Executed on -----~Da:;:te:------- Executed on ------;;:Da:;:te:------- www.netfile.com BY~~tr+rr\rffi~~~~~~~~~~~~------~, By _________ -.~~~~~~~~~~~~~~~~~-----------Signature 01 Controlling OffICeholder. Candidate. State Measure Proponent By ______ ~~~~~~~~~~~~~~~~~~-------SIgnature of Controlling OffICeholder. Candidate. State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3n2) www.fppc.ca.gov