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Form 497- Yes on Measure D (2016-05-23)497 Contribution Report NAME OF FILER Committee to Support San Rafael Libraries - Yes on Measure D AREACODE/PHONE NUMBER I.D. NUMBER (Wapplica6/e) 415-446-4222 11383895 1000 Fourth Street, Suite 600 CITY San Rafael 1. Contribution(s) Received Amounts may be rounded to whole dollars. STATE ZIP CODE CA 94901 Date of 5/23/2016 This Filing 7 Report No. ❑ Amendment to Report No. (explain below) No. of Pages 1 MAY 2 3 2016 ITY CLERK'S OFFI DATE FULL NAME, STREETADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR WAN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) RECEIVED San Rafael Police Association Political Action Committee ❑ IND 1,000 910 D Street ❑X COM 5/21/2016 San Rafael, CA 94901 ❑ OTH ❑ Check if Loan FPPC# 831553 ❑ PTY ❑ SCC % Provide interest rate ❑ IND ❑ COM ❑ OTH ❑ Check if Loan ❑ PTY ❑ SCC % Provide interest rate ❑ IND ❑ COM ❑ OTH ❑ Check if Loan ❑ PTY ❑ SCC Provide interest rate Reason for Amendment: —Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 497 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov