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Form 497- Yes on Measure D (2016-03-24)497 Contribution Report Amounts may be rounded to whole dollars. 415-446-4222 1383895 Report No. ___ 2 __ _ NAME OF FILER Date of 3/24/2016 Committee to Support San Rafael Libraries -Yes on Measure 0 This Filing _____ _ ---------~~------------r_--_==_----------------~ AREA CODE/PHONE NUMBER 1.0. NUMBER (if applicable) STREET ADDRESS 0 Amendment 1000 Fourth Street, Suite 600 to Report No. _______ _ -C-ITY------------------S:::T.="A=:rE=------=ZI:=P-:::C:-::O=D-=E-----1 (explain below) San Rafael CA 94901 No. of Pages ___ 1-'---__ 1. Contribution(s) Received DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR RECEIVED (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) CODE * Friends of San Rafael Public Library 0 INO 1100 E Street 0 COM 3/24/2016 San Rafael, CA 94901-1900 ~ OTH 0 PTY 0 sec 0 INO 0 COM 0 OTH 0 PTY 0 sec D INO D COM 0 OTH 0 PTY 0 sec Reason for Amendment: ________________________________ _ Date Stamp CALIFORNIA 497 enO,,/I I ""' .. , ••• Y I!_. II ' , 1o)l§©l§O lffi MAR 2 4 y CITY CLERK'S FFICE IF AN INDIVIDUAL , ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOYED, ENTER NAME OF BUSINESS) -Contributor Codes IND -Individual AMOUNT RECEIVED 15,000 o Check if Loan % Provide interest rate o Check if Loan % Provide interest rate o Check if Loan % Provide interest rate 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 497 Contribution Report Amounts may be rounded to whole dollars. Date of This Filing __ 3_/2_4_/2_0_1_6_ NAME OF FILER Committee to Support San Rafael Libraries -Yes on Measure D AREA CODE/PHONE NUMBER Report No. ___ 2 __ _ 415-446-4222 I.D. NUMBER (ifapp/icab/e) 1383895 STREET ADDRESS 0 Amendment 1000 Fourth Street, Suite 600 to Report No. ____ _ -C-llY------------------S::::T,=-=A=rE=----=Z=lpc-:C=-=O:-::D=E-----i (explain below) San Rafael CA 94901 No.ofPages ___ ~1 __ _ 1. Contribution(s) Received DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR RECEIVED (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) CODE * Friends of San Rafael Public Library 0 IND 11 00 E Street 0 COM 3/24/2016 San Rafael, CA 94901-1900 ~ OTH 0 PTY 0 sec 0 IND 0 COM 0 OTH 0 PTY 0 sec 0 INO 0 COM 0 OTH 0 PTY 0 sec Reason for Amendment: _________________________________ __ Date Stamp CALIFORNIA 497 FORM IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOYED. ENTER NAME OF BUSINESS) -Contributor Codes IND -Individual y AMOUNT RECEIVED 15,000 o Check if Loan % Provide interest rate o Check if Loan % Provide Interest rate o Check if Loan % Provide interest rate 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