HomeMy WebLinkAboutForm 410 - Revitalize San Rafael Libraries and Community Center Ad Committee's Top Funder San Rafael Public Library FoundationStatement of organization
Recipient Committee
Statement Type ® Initial ❑ Amendment
® Not yet qualified
Date qualification threshold met Date qualification threshold met
Ul / 19
I.D. Number
❑ Termination — See Part 5
NAME OF COMMITTEE
Revitalize San Rafael Libraries and Community
Center Ad Committee's Top Funder San Rafael
(public Library Foundation
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREACODE/PHONE
San Rafael CA 94901
E-MAILADDRESS OF COMMITTEE (REQUIRED)/ FAX (OPTIONAL)
COUNTY OF DOMICILE JU RISDICTION WHERE COMMITTEE 15 ACTIVE
Marin San Rafael
Attach additional information on appropriately labeled continuation sheets,
Date of termination
NAME OF TREASURER
Charles H Stuckey
STREET ADDRESS (NO P.O. BOX)
EMAIL ADDRESS OF TREASURER (REQUIRED)
NAME OF ASSISTANT TREASURER, IF ANY
Charles P Litchfield
STREET ADDRESS (NO P.O. BOX)
EMAIL ADDRESS OF ASSISTANT TREASURER I
NAME OF PRINCIPAL OFFICERS)
Joseph O'Hehir
Date Stamp
CITY
San Rafael
CITY
San Rafael
STREET ADDRESS (NO P.O. BOX) CITY
San Rafael
EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED)
For Official Use ODIY
STATE 21P CODE
CA 94901
AREA CODE/PHONE
STATE ZIP CODE
CA 94901
AREA CODE/PHONE
;TATE ZIP CODE
CA 94901
I have used all reasonable diligence in
CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410(October/2023)
FPPC Advice:dviccilPppc.cz.pny,(866/275-3772)
Www.f Uc.ca,gov_
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D. NUMBER
Revitalize San Rafael Libraries & Community Center: Ad Committee's Top Funder San Rafael Public Library Foundation
All committees must list the financial institution where the campaign bank account is located and the person(s) authorized to obtain bank records.
NAME OF FINANCIAL INSTITUTION AND PERSON(S) AUTHORIZEDTO OBTAIN BANK RECORDS AREACODE/PHONE BANK ACCOUN INUMBER
Bank of Mann 415-485-2265 02826231
OF FINANCIAL INSTITUI ION CITY STATE ZIP CODE
1101 Fourth Street San Rafael CA 94901
fI Y iV'WM
• 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 CHFCK nNF
Nonpartisan
Partisan
(list political party below)
Nonpartisan
Partisan
(list Political parry below)
Primarily formed to support or oppose specific candidates or measures in a single election. list below:
CANDIDATES) NAME OR MEASUREIS) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
IF A RFrAI I CTATF "RFCAI I" IN FRONT nF THE OFFICIPHOLDER'S NAME. (INCLUDE DsI RIOT NO.. CITY OR COUNTY, AS APPLICABLE) CHFCK ONF
San Rafael Public Libraries and Community Center Initiative
Marin County, San Rafael, CA
sUPPORr
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410(October/2023)
FPPCAdvice: advice@fgpc.ca.gov_.(S66/275-3772)
www: p�c_ca�nv_
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
Revitalize San Rafael Libraries & Community Center: Ad Committee's Top Funder San Rafael Public Library Foundation
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 JINDUITRY GROUP OR AFFILIATION OF SPONSOR
San Rafael Public Library Foundation Nonprofit Organization
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA 94901
— 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 (October/2023)
FPPC Advice: advice _ fp c.ca�ov_(866/275-3772)
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