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Home My WebLink AboutForm 460 - Greg Brockbank for City Council 2013 (2014-12-31)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Type or print in ink. Statement covers period from 7/1/14 SEE INSTRUCTIONS ON REVERSE through 12/31/14 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee EJ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Parl 5) 0 Sponsored (Also Complete Part 6) ❑ General Purpose Committee 0 Sponsored E] Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1 1355049 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) STREET ADDRESS (NO P.O. BOX) 35 St. Francis Lane CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 415-717-7056 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS Date of election if applicable: (Month, Day, Year) COVER PAGE Page __L_ of For Official Use Only Time: 11/5/13 city Clerk's Office 2ian Rafael 2. Type of Statement: Preelection Statement Quarterly Statement Semi-annual Statement Special Odd -Year Report ❑ Termination Statement E] Supplemental Preelection (Also file a Form 410 Termination) Statement -Attach Form 495 E] Amendment (Explain below) Treasurer(s) NAME OF TREASURER Greg Brockbank MAILING ADDRESS 35 St. Francis Lane CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 415-717-7056 NAME OF ASSISTANT TREASURER IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX I E-MAIL ADDRESS 415-472-7400 / greg@marinlawcenter.com 415-472-4400 / greg@marinlawcenter.com 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on By Date Signature of Treasurer or Assistant Treasurer Executed on By Date Signature of Controlling Officeholder Candidate, State Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date SignatLireofControllingOfficeholderr Candidate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) State of California Type or print in ink. COVERPAGE-PART2 Recipient Committee Campaign Statement Cover Page — Part 2 F Page Of 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE GREG BROCKBANK OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Councilmember, City of San Rafael RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Identify the controlling officeholder, candidate, or state measure proponent, if any. 35 St. Francis Lane San Rafael, CA 94901 NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D.NUMBER 7. Primarily Formed Candidate/Officeholder Committee List names of NAME OF TREASURER CONTROLLED COMMITTEE? officeholder(s) or candidate(s) for which this committee is primarily formed. [:] YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD Ej SUPPORT F] OPPOSE COMMITTEE NAME I.D.NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD❑ SUPPORT E] YES E] NO ❑ OPPOSE COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-3772) State of California �� print in ink. Amounts Statement �moupn»'v»ue»nvnuo Summary Page to whole dollars. SEE INSTRUCTIONS owREVERSE NAME OF FILER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1. MonetaryContribudons------------ --. Schedule « Line a u 2. LuansRaoaivad------------------ Schedule B, Line 3. 8UBTOTALCAGHCONTRIBUTIONS .......... ............ Add Lines /~o $ 4. NnnmnnntaryCnntribuhunu--------- --- Schedule C, Line O O Fxpenditures Made Statement covers nonnu from 7/1/14 Em Column Column mTALrHISPERIOD aLENDARYEAR (FROM ATTACHED SCHEDULES) rmxooDATE 100�00 a 815.00 O O � � 10000 G150O � O U 10000 81500 O. Payments Made .................... ...... ........ —... .... .... . Schedule E, Line* $ O m 7. Loans Made ................ ...... —.... —... ............. ..... Schedule H,Line o 0 O. SUBTOTALCAGHPAvMENTS------------ Admu"es*~r $ O $ S. Accrued Expenses (Unpaid Bi||e)-------- Schedule F Line 3 « 10.Nonmvnetary Adjustment ........................... —... ---Schedule C, Linea u 11.TOTAL EXPENDITURES MADE ...... ....................... Add Lines o~o~m y v y 12. Beginning Cash 8olanoe-------' Previous Summary Page, Line 16 a 13, Cash Receipts ----------------- Column A, Line aabove 14. Miscellaneous Increases to Cash--------- Schedule 1,Line 4 15. Cash Payments .............................. ............... ... Column A, Line oabove 16. ENDING CASH BALANCE .......... Add Lines ,c~m~/4,then subtract Line /s m nthis metermination statement, Line /amust uozero. Cash Equivalents and Outstanding Debts 1O.Cash Equivalents ......... ............................ _ See instructions vnreverse $ 2151.45 100.00 0 2251.45 455,00 455.00 O O 455.00 To calculate Column B.add amounts /nColumn Amthe corresponding amounts from Column smyour last report. Some amounts m Column Amay be negative figures that should ue subtracted from previous period amounts. |fthis is the first report being filed for this calendar year, only carry over the amounts � from Lines o.r.and s(if SUMMARY PAGE 12131/14 Page 13 of 1355049 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20. Contributions Received ou | o/. Expenditures | Mom, $________- $ Candidates ozCumulative Expenditures Made* (if Subject mVoluntary Expenditure Limit) Date o,Election Total mDate (mm/dd/yy) $________ | $-------- | Amounts in this section may be different from amounts reported in Column B. pppnForm wm(Jaouary/05) Schedule A Type or print in ink. SCHEDULE A onetary Contributions Received Amounts may be rounded to whole dollars. Statement covers period I ®' 7/1x14 from ®. 12/31:/:1:4-- 2/31/ 14 through page _ of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED OF COMMITTEE, ALSO ENTER LD.NUMBER) CODE (IF SELF-EMPLOYED .ENTER NAME PERIOD (JAN. 1 -DEC, 31) (IF REQUIRED) OF BUSINESS) ®IND 8/4/14 Kenneth King ❑COM retired 100.00 100.00 POB 4278 ❑OTH San Rafael, CA 94903 ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY [_]SCC - - ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ 100.00 1 Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.) ... .. .............. $ 100.00 2. Amount received this period — unitemized monetary contributions of less than $100 ..... 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ............ L ........... $ I `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 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) SCHEDULED Summary of Expenditures Type or print in ink. Statement - covers period Supporting/Opposing Other Amounts may be rounded dollars. to whole 7/1/14 Candidates, Measures and Committees from through 12/31/14 page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 CUMULATIVE TO DATE PER ELECTION DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR TYPE OF PAYMENT DESCRIPTION AMOUNT THIS CALENDAR YEAR TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, flF REQUIRED) PERIOD (JAN, I - DEC. 31) (IF REQUIRED) OR COMMITTEE ❑ Monetary Contribution Ej Nonmonetary Contribution E] Independent ❑ Support F1 Oppose Expenditure Monetary Contribution Nonnnonetary Contribution ED] Independent Ej Support F-1 oppose Expenditure Monetary Contribution Ej Nonnionetary Contribution Independent ❑ Support E] oppose Expenditure SUBTOTAL $ Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (include all Schedule D subtotals.) ...... ...... _ ............................... $ 2. Uniternized contributions and independent expenditures made this period of under $100 ... ........................... __ .... ...... _ ........... 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) .... ......... $ FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)