HomeMy WebLinkAboutForm 410 - Police Association PAC Amend 08-05-19Statement of Organization
Recipient Committee
Statement Type ❑ Initial Q Amendment
Q Not yet qualified
or
Q Date qualification threshold met Date qualification threshold met
❑ Termination — See Part 5
Date of termination
StampCALIFORNIA
UG - 7 201FORM 4
Dr Official Use only
C'(Date
CLERK'S 0 FICE
3. Verification
I have used all reasonable diligence in preparing 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 C ornia that the foregoing is true and correct.
Executed on 815, 2019 By
DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on I By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE
netfile.com
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
01 / 01 �/ 1983
/
. mmfee fofortdaWn 'I.D.
Number
I Treasurer and Other Principal Officers
(if applicable) 831553
NAME OF COMMITTEE
NAME OF TREASURER
San Rafael Police Association Political Action Committee
Ms. Beth Minka
STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
San Rafael
CA
94901
(
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
San Rafael CA 94901 (
Ms. Stacy E. Owens
FULL MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
San Rafael, CA 94915-1557
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
Oakland
CA
94607
(
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE IS ACTIVE
NAME OF PRINCIPAL OFFICER(S)
Marin County, CA
Mr. Carl Huber, President
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
San Rafael
CA
94901
(
3. Verification
I have used all reasonable diligence in preparing 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 C ornia that the foregoing is true and correct.
Executed on 815, 2019 By
DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on I By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE
netfile.com
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
GAILIFO&AIA 41 U
.-
INSTRUCTIONS ON REVERSE
Page 2 of 4
COMMITTEE NAME
I.D. NUMBER
831553
San Rafael Police Association Political Action Committee
2a. Additional Officers / Assistant Treasurers
NAME
NAME
Kyle Hornstein, Vice President
MAILING ADDRESS
MAILING ADDRESS
CITY STATE ZIP CODE
AREA CODE/PHONE
CITY
STATE
ZIP CODE AREA CODE/PHONE
San Rafael CA 94901
(
NAME
NAME
MAILING ADDRESS
MAILING ADDRESS
CITY STATE ZIP CODE
AREA CODE/PHONE
CITY
STATE
ZIP CODE AREA CODE/PHONE
NAME
NAME
MAILING ADDRESS
MAILING ADDRESS
CITY STATE ZIP CODE
AREA CODE/PHONE
CITY
STATE
ZIP CODE AREA CODE/PHONE
NAME
NAME
MAILING ADDRESS
MAILING ADDRESS
CITY STATE ZIP CODE
AREA CODE/PHONE
CITY
STATE
ZIP CODE AREA CODE/PHONE
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
3 of 4
COMMITTEE NAME I I.D. NUMBER
San Rafael Police Association Political Action Committee 831553
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
Union Sank
ADDRESS
AREA CODE/PHONE
(
CITY
BANK ACCOUNT NUMBER
STATE ZIP CODE
San Rafael CA 94901
aff88 Gom ie"e appikabille sections.
• List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and
district number, if any, and the year of the election.
• List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." Stating "No party preference' is acceptable.
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY
(INCLUDE DISTRICT NUMBERIFAPPLICABLE) ELECTION CHECKONE
Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
OPPOSE
OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
I.D. NUM
San Rafael Police Association Political Action Committee
Type of CvMtlrtir We (continued)
Page 4 of 4
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑x CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
To make political contributions to support and oppose candidates and issues of interest to the San Rafael Police Association.
• • List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
San Rafael Police Association Union
STREETADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODEIPHONE
San Rafael CA 94901 (
t���xm�s��u�a.nnui•rnuuuurr:a ❑
Date qualified
5, Termination RegUirements By signing#e—veri cation, the treasurer, assistant treasurer and/or candidate, o ofder, or mpotsentcaer# £p fhat all afi thefoftawingi� have E met:
�• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
• This committee has no surplus funds; and
• This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
-- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government
Code Section 89519.
-- Leftover funds of ballot measure committees may be used for po itical, legislative or governmental purposes under Government Code Sections 89511- 89518, and are
subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov