HomeMy WebLinkAboutForm 410 - Eli Hill for San Rafael City Council D2 2022; TerminationStatement of Organization
Recipient Committee
Statement Type ❑ Initial ❑ Amendment ® Termination — S
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For Official Use Only
NAME OF COMMITTEE
NAME OF TREASURER
Eli Hill for San Rafael D2 2022
Eli Hill
STREETADDRESS (NO P.O. BOX)
9
(NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
9
Rafael
CA
94901
415-
STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
San Rafael
CA 94901 415-
MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
E-MAIL ADDRESS (REQUIRED)/FAX (OPTIONAL)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE 15 ACTIVE
NAME OF PRINCIPAL OFFICER(S)
Marin
City of San Rafael
STREETADDRESS (NO P.O. BOX)
Attach additional information on appropriately labeled continuation sheets.
CITY STATE ZIP CODE
AREA CODE/PHONE
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 California that
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 (August/2028)
FPPC Advice: advic :fn ; pc.ca,gyy (866/275-3772)
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Statement of Organization CALIFORNIAi
Recipient Committee • -
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D. NUMBER
Eli Hill for San Rafael City Council D2 1439056
All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Mechanics Bank 415-460-6080
ADDRESS CITY STATE ZIP CODE
904 4th Street San Rafael CA 94901
• 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.
ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
Eli Hill for San Rafael City Council D2 2022
San Rafael City Council
2022
Nonpartisan
Partisan
(list political party below)
Nonpartisan
Partisan
(list political party below)
• 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) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
IF A RECALL, STATE -RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: adviceC�oj c.c z2a (866/275-3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
NAME OF SPONSOR
STREET ADDRESS NO, AND STREET
CITY
GROUP OR AFFILIATION OF SPONSOR
Page 3
STATE ZIP CODE AREACODE/PHONE
— 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 political, 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: ggyji �Ev (866/275-3772)
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