HomeMy WebLinkAboutForm 410 - Firefighters' Association PAC (2015-01-30) AmendmentStatement of Organization
Recipient Committee
Statement Type 0 Initial
Not yet qualified El or
0 Amendment
List I.D. number:
# 819308
Date qualified as committee
(if applicable)
® Termination — See Part S
List I.D. number:
Date of Termination
1. Committee Information
NAME OF COMMITTEE
San Rafael Firefighters Political Awareness Committee
STREETADISRESS (NS) P.O. BOX)
CITY
STATE zip CODE AREA CODE/PHONE
San Rafael 94901 (
- MAFL1NGACWDRESSNFTDIFFERENT)
RISDIC'NON WHERE COMMITTEE IS ACTIVE
BE
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Andrew Rogerson
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Rohnert Park Ca 94928 (
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODEIPHONE
NAME OF PRINCIPAL OFFICERS)
Rob Winner
STREET ADDRESS (NO RQ. BW
CITY STATE ZIP CODE AREA CODE/PHONE
Executed on By
DATE
SIGNATURE OF CCINTROMMG OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Dec/2012)
PPC AdAce�7dvice@fpqc.ca.6*v (t56/275-3772)
www.fppc.ca.gov