HomeMy WebLinkAboutForm 410- Yes on Measure D AmendmentStatement of Organization
Recipient Committee
Statement Type o Initial
Not yet qualified r;z] or
--~/--_J!--~
Date qualified as committee
1. CorTu;nitt.ee.l nformation
NAME OF COMMITTEE
I;zJ Amendment
List I.D. number:
# 1383895
03 /09 /2016
Date qualified as committee
(If applicable)
o Termination -See Part 5
List I.D. number:
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Date of Termination
2. Tre~surer-a
NAME OF TREASURER
Committee to Support San Rafael Libraries -Yes on Measure 0 Dirck W. Brinckerhoff
STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS (NO P.O. BOX) CITY
1000 4th Street, Ste. 600 San Rafael
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
San Rafael, CA 94901 ( Jeffrey Schoppert
MAILING ADDRESS (IF DIFFERENT) STREET ADDRESS (NO P.O. BOX)
P.O. Box 150488, San Rafael, CA 94915
FAX / E'MAIL ADDRESS CITY
San Rafael
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
Marin City of San Rafael Jeffrey Schoppert
STREET ADDRESS (NO P.O. BOX)
CITY
Attach additional information on appropriately labeled continuation sheets.
San Rafael
STATE ZIP CODE AREA CODE/PHONE
CA 94903 (
STATE ZIP CODE AREA CODE/PHONE
CA 94901 (
STATE ZIP CODE AREA CODE/PHONE
CA 94901 (
-3. Verification .:. ,.' "., _ . 1 •• :, .
f have' used a il rea sonable "d'fi igence in 'p(;paring t his -state iTIent a ~d to the -bestof" my kn-ow ledge the information~c-onta 'in;d herein is'-tr~e a~d complete: I c ertifY 'under
penalty of perjury under the laws of the State f California that the foregoing is true and correct.
~~oo OY1m016 ~-1~([===~=='~-~~~==~====-----------SIGNATURE OF TREASURER OR ASSISTANT TREASURER DATE
Executed on
DATE
By
Executed on By
DATE
Executed on By
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER , CANDIDATE, OR STATE MEASURE PROPONEN T
SIGNATURE OF CONTROlLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER , CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
'.
Statement of Organization
Recipient Committee
Amendment 3-18-2016
Committee to Support San Rafael Libraries -Yes on Measure D
Continuation sheet:
2. Treasurer and Other Principal Officers
Additional Principal Officer:
Glena Coleman
San Rafael, CA 94901 (
California Form 41 0
ID Number: 1383895
'.
Statement of Organization
Recipient Committee
INSTRUCTIONS or~ REVERSE
CO MM IT EE rHIME
Committee to Support San Rafael Libraries -Yes on Measure 0
• All committees must list the financial institution where the campaign bank account is located.
r ~At.~E O F FINAflC'Allt~S T TL T l0 ~J AREA CODE/PHO~JE
Bank of Marin (415)485-2265
ADDRESS
1101 4th Street San Rafael
4. Type of Committee Complete the applicable sections.
Controlled Committee
O.;r'K ACCOUIlT 'lUMBER
STATe :IP CODE
CA 94901
CALIFORNIA 41 0
FORM
r D NUr.18ER
1383895
• List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the electlVe office sought or held, and
district number, If any, and the year of the election .
• List the political party w i th which each officeholder or candidate is affiliated or check "nonpartisan."
• If this committee act s jointly with another controlled committee, list the name and identification number of the other controlled committee
NAME OF CANDIDATE/OFFICEHOLDER/STAlE MEASURE PROPONENT
ELECTI V E OFFICE SOUGHT O R HE LD
(INCLUDE DISTRICT NUMBER IF APPLIC A BLE) YEAR OF ELECTION
Primarily Formed Committee ~ . Prima rily formed to sup port or oppo se specific candidates or measures In a smgle election . List below:
CANDIDATEiS) NAME OR M EASURE(S) FULL TI TL E (II e l.UDE BALLOT NO O R LETTER)
San Rafael Special Library Services Parcel Tax MeasureO
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASUR~(~) JURIS[)ICTION
IINllUDE DISTRICT NO , CITY OR COUNTY, A5 APPLICABLE)
City of San Rafael
PAR T;
o Nonpartlsan
o Nonparnsan
CHECK O~Jr: . -
S U ~PORT OPPOSE
0 D
5l0 l 00
FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRU CTIONS ON REVERSE
C OMr~lnEE N"ME
Committee to Support San Rafael Libraries -Yes on Measure 0
4. Type of Com!!,ittee (Continued)
CALIFORNIA 41 0
FORM
10 NUMBER
a 1383895
General Purpose Committee . -Not formed to support or oppose specific candidates or measures in a single electlO n. Check only one box : o CITY Committee 0 COUNTY Committee 0 STATE Committee
pQOVloe BRIEF DESCRIPTIOU 0;: ACTIVITY
Sponsored Committee . List add i tional sponsors on an attachment.
flAME Of SPONSOR !NDUSTRY GROUP OR AFFllIATlC~~ OF sPo,.SOrt
~TREn ~DD"ESS NO AND STR(ET cln ZIP C~DE
Small Contributor Committee -0_-1_-1 __
5. Termination Requirements By signing the verification, the treasurer,_ assist~nt treasurer and/or candlda~, officeholder, or proponent certify that all of the following conditlons have been met:
• This committee has ceased to receive contributions and make expenditures;
• ThiS committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no intention or ability to discharge all debts, loans re ceived, and other ob ligations;
• This committee has no surplus funds; and
• This committee has filed all campa ign statements requ i red by th e Political Reform Act disclosing all reportable transactions .
--There are restrictlons on the disposition of surplus campaign funds held by elected officers who are leavin g office and by defeated candidates. Refer to Government
Code Section 89519.
--Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Section s 89511 -89518, and are
subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov