HomeMy WebLinkAboutForm 410 - Carolina Martin for San Rafael School Board Trustee 2022; Amendment 01-31-24 (State)Statement of Organization
Date Stamp
RecipGsnt Committee
DIGITALLY
ECEIVED AND FILED
Statement Type
❑ Initial
® Amendment
❑ Termination — See Part 5
O Not yet qualified
in the office of the California
Secretary of State
or
O Date qualification threshold met
Date qualification threshold met
Date of termination
January 31, 2024
07 / 29 1 2022
® I.D. Number
ppi-ble) 1449397
Treasurer and OtherOfficers
NAME OF COMMITTEE
NAME OF TREASURER
Chelsea Johnson
Carolina Martin for San Rafael City Schools District 4 2022
STREETADDRESS (NO P.O.BOX) CITY
371
EMAIL ADDRESS OF TREASURER (REQUIRED)
chelsea@cjandassociatesinc.
ADDRESS (NO P.O. BOX)
371
OF ASSISTANT TREASURER, IF ANY
CITY STATE ZIP CODE AREA CODE/PHONE
Lakeport CA 95453 (916)
ADDRESS (NO P.O. BOX) CITY
FULL MAILING ADDRESS (IF DIFFERENT)
EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED)
E-MAIL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL)
martin@cjandassociatesinc.
OF PRINCIPAL OFFICER(S)
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE IS ACTIVE
Marin
City of San Rafael
STREET ADDRESS (NO P.O. BOX) CITY
P C=i�� �-�
21024
rl:
STATE ZIP CODE
CA 95453
AREA CODE/PHONE
(916)
ZIP CODE
AREA CODE/PHONE
STATE ZIP CODE
Attach additional information on appropriately labeled continuation sheets. EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED) 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 the foregoing is true and correct.
Executed on 01/28/2024 By z,
CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
Executed on
DATE
netflfe. Coln
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410(October/2023)
FPPC Advice: advicet@fppc.ca.gov (866/275-3772)
wwwJPPc.ca.gov
Statement of Organization
�.: - -Reciprrt Crn»mtttee
INSTRUCTIONS ON REV SE
COMMITTEE NAME
Carolina Martin for San'Rafael City Schools District 4 2022
Page 2 of 4
I.D. NUMBER
1449397
• All committees must listhe 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) AUTHORIZED TO OBTAIN BANK RECORDS AREA CODE/PHONE BANK ACCOUNT NUMBER
First Foundation Bank (916)724-2424
ADDRESS OF FINANCIAL INSTITUTION CITY STATE ZIP CODE
2233 Douglas Blvd., Ste. 300 Roseville CA 95661
• List the name of each'controlling officeholder, candidate, or state measure proponent. If candidate or officeholder coritrolied,
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
Carolina Martin
Board of Education City of San Rafael
District 4
2022
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) FULLTITLE (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 (October/2023)
FPPC Advice: advice(@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recip amt Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Carolina Martin for San Rafael City Schools District 4 2022
Page 3 of 4
I.D. NUMBER
1449397
General Purpose Committee 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 INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
❑ //
•--. -
S.TerminationRequirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, orponentcertify that all ofthe following conditions have been 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 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@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Carolina Martin for San Rafael City Schools District 4 2022
Additional Mailing Address: San Rafael, CA 94901
Page 4 of 4
I.D. NUMBER
1449397
FPPC Form 410 (October/2023)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov