HomeMy WebLinkAboutForm 410- Rachel Kertz for City Council 2020; termination stateStatement of Organization
Date Stamp
CALIFORNIA
Recipient Committee
DIGITALLY
• -
, '
Statement Type
❑ Initial
® Amendment
® Termination — See Part 5
RECEIVED AND FILE
in the office of the Californ2
or
CI y
Q Not yet qualified
Secretary of State
July 28, 2023
IE
or
O Date qualification threshold met
Date qualification threshold met
Date of termination
AU
2U23
08 / lam/ 2020
06 30 / 2023
f
rt �3rt►II#ftlte+li�i
a`a ' ..
I.D. Number
(if applicable) 1427074
. 'i�tl trtC tlt #t�ltrtp�ti Efl I� m�
NAME OF COMMITTEE
Rachel Kertz for City Council 2020
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE AREA CODE/PHONE
Antelope
CA 95843 (
FULL MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE IS ACTIVE
Marin
City of San Rafael
Attach additional information on appropriately labeled continuation sheets.
NAME OF TREASURER
Chelsea Johnson
STREET ADDRESS (NO P.O. BOX)
CITY
Antelope
STATE
CA
ZIP CODE
95843
AREA CODE/PHONE
(
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
NAME OF PRINCIPAL OFFICERS)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
�✓`� yeti ;�C�iIC�I'f; _ _ _ _ t � � 5 >�,I �:
s 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 the foregoing is true and correct.
Executed on 7/25/2023
OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
Executed on
By
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
wwwJppc.ca.gov
netfilexorn
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Rachel Kertz for City Council 2020
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
First Foundation Bank
ADDRESS
AREA CODE/PHONE
(916)724-2424
CITY
BANK ACCOUNT NUMBER
STATE ZIP CODE
IS.A@Lj&ffaY:7
2 of 3
1427074
2233 Douglas Blvd., Suite 300 Roseville CA 95661
.. y �,.
• 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 ONF
Rachel Kertz
City Council Member City of San Rafael
District 4
2020
Nonpartisan
X
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)
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
T I OPPOSE
1-120-MA
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
Page 3 of 3
COMMITTEE NAME I.D. NUMBER
Rachel Kertz for City Council 2020
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
Sponsored Committee List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
J
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
❑
Date qualified
• 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 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: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov