Loading...
HomeMy WebLinkAboutForm 465 - Police Association PAC (2011-10-22) Supporting Gary PhillipsSupplemental Independent Expenditure Report (Government Code Section 84203.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be rounded to whole dollars. ❑ Amendment (Explain Below) I.D. NUMBER (if recipient committee) 1. Committee/Filer Information 831553 COMMITTEE/FILER'S NAME San Rafael Police Association Political Action Committee STREET ADDRESS (NO P.O. BOX) 1520 Fifth Avenue CITY STATE ZIP CODE AREA CODEIPHONE San Rafael CA, 94901 (415) 485-3000 OPTIONAL: FAX/E-MAIL ADDRESS Report covers period from 09/25/2011 through 10/22/2011 Date of election if applicable: (Month, Day, Year) 11/08/2011 Treasurer (if recipient committee) NAME OF TREASURER Mr. Scott Ingels MAILING ADDRESS 1520 Fifth Avenue SUPPLEMENTAL Date Stamp 0 EXPENDITURE Page 1 of 3 For Official Use Only CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA, 94901 (415) 485-3000 OPTIONAL: FAX/E-MAIL ADDRESS 2. Name of Candidate or Measure Supported or Opposed CHECKONE NAME OF CANDIDATE Gary Phillips OFFICE SOUGHT OR HELD AND DISTRICT, IF APPLICABLE Mayor City of San Rafael, CA SUPPORT X OPPOSE NAME OF BALLOT MEASURE BALLOT NO./LETTER JURISDICTION SUPPORT OPPOSE 3. Independent Expenditures Made Attach additional information on appropriately labeled continuation sheets. CUMULATIVE TO DATE DATE NAME AND ADDRESS OF PAYEE DESCRIPTION OF EXPENDITURE AMOUNT (JAN. Freeman Public Affairs, Inc. 4,648.66 Mailer including production and postage 10/17/2011 1405 Marcelina Avenue, Suite 111 in support of Gary Phillips for San 20,115.73 Rafael Mayor. Torrance, CA 90501 U.S. Postmaster 2,100.00 Postage for mailer in support of Gary MEMO 10/17/2011 1433 Marcelina Avenue Phillips for San Rafael Mayor Subpayment made through: Freeman Public ffairs, Torrance, CA 90501 Inc. Freeman Public Affairs, Inc. 6,473,00 Mailer including production and postage 10/19/2011 1405 Marcelina Avenue, Suite Ill in support of Gary Phillips for San 20,115.73 Rafael Mayor. Torrance, CA 90501 FPPC Form 465 FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Supplemental Independent Type or print in ink. Expenditure Report Amounts may be rounded p P to whole dollars. SEE INSTRUCTIONS ON REVERSE For use by an officeholder, candidate, or committee making independent expenditures totaling $500 or more in a calendar year to support or oppose a single candidate or a single measure. This form must be filed at the same times and places as the campaign statements filed by the candidate supported or opposed or by a committee primarily formed to support or oppose the measure. A separate form must be filed for each candidate or measure being supported or opposed. This form is filed in addition to anv other required campaign statements. Report covers period from 09/25/2011 through— 10/22/2011 Date of election if applicable: (Month, Day, Year) 11/08/2011 Page 2 of 3 For Official Use Only iv i naepenaeni DATE txpenanures mase Attacn aaditionat intonnatron on appropnateiy iaoetea continuation sneets. CALENDAR YEAR NAME AND ADDRESS OF PAYEE DESCRIPTION OF EXPENDITURE AMOUNT (JAN. 1 - DEC. 31) 10/19/2011 U.S. Postmaster 1433 Marcelina Avenue Torrance, CA 90501 Postage for mailer in support of Gary Phillips for San Rafael Mayor 3,150.00 MEMO Subpayment made Freeman Public Inc. through: %ffairs, Supplemental Independent Type or print in ink. SUPPLEMENTAL INDEPENDENT EXPENDITURE Amounts may be rounded Report covers period Expenditure Report to whole dollars. from 09/25/2011 10/22/2011 SEE INSTRUCTIONS ON REVERSE through Page 3 of 3 NAME OF FILER I.D. NUMBER (if recipient corn.) San Rafael Police Association Political Action Committee 831553 4. Summary 11,121.66 1. Total independent expenditures of $100 or more made this period. (Part 3.) ........................................................................................... $ 2. Total independent expenditures under $100 made this period. Not itemized......................................................................................... $ 0.00 3. Total independent expenditures made this period (Add Lines 1 + 2.) ..........................................................................................TOTAL $ 11,121.66 5. Filing Officers Enter the name and address of each filing officer with whom the filer's most recent campaign statements (Form 450, 460 or 461) have been filed. 1) NAME OF FILING OFFICER 3) NAME OF FILING OFFICER San Rafael City Clerk ADDRESS (NO. AND STREET) ADDRESS (NO. AND STREET) 1400 5th Avenue CITY STATE ZIP CODE CITY STATE ZIP CODE San Rafael, CA 94901 2) NAME OF FILING OFFICER 4) NAME OF FILING OFFICER ADDRESS (NO, AND STREET) ADDRESS (NO. AND STREET) CITY STATE ZIP CODE CITY STATE ZIP CODE 6. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein 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 SIGNATW OF FILER, 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 SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT FPPC Form 465 FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)