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Home My WebLink AboutForm 410 - Revitalize San Rafael Libraries and Community Center Ad Committee's Top Funder San Rafael Public Library Foundation; State� 14(o� 55(0 MAR 1 E 2024 CITY CLERK'S OFFICE RECEIVED AND FILED in the office of the Secretary of State 2 I of the State of California FEB 2 8 7074 Statement of Organization Recipient Committee Statement Type 9 Initial ❑ Amendment ❑ Termination — See Part 5 0 Not yet qualified or 0 Date qualification threshold met Date quallfication threshold met Date of termination I.D. Number IAME OF COMMITTEE Revitalize San Rafael Libraries and Community Center Ad Committee's Top Funder San Rafael Public Library Foundation 109 STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 415- MAILING ADDRESS OF DIFFERENT) P. MAIL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL) Chuckstuckey@hotmail. OF DOMICILE JURISDICTION WHERE COMMITTEE 15 ACTIVE Marin I San Rafael Attach additional information on appropriately labeled continuation sheets. NAME OF TREASURER Charles H Stuckey STREET ADDRESS INC P.O BOX) CITY 109 Rafael EMAIL ADDRESS OF TREASURER (REQUI RED) chuckstuckey@hotmail. OF ASSISTANT TREASURER, I F ANY Charles P Litchfield STREET ADDRESS (NO P.O. BOX) CITY 828 Rafael EMAIL ADDRESS OF A551STANT TREASU RER (REQUIRED) charlit@gmail. O'Hehir For Official Use Only STATE ZIP CODE CA 94901 AREA CODE/PHONE 415- ZIP CODE CA 94901 AREA CODE/PHONE 415- ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE 31 Rafael CA 94901 EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED) AREA CODE/PHONE johehir62@gmail. used all reasonable diligence in preparing this statement ASSHTANTTREASURER Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on DATE BY SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE, ON 51AlC MEASURC PROAON[NT Executed on DATE BY SIGNATURE Of CONTROLLING OFF itENOLDEN, CANDIDATE, OR STATE MEASURE MIOpONI N r FPPC Form 410 (October/2023) FPPC Advice: a dvi c c -a f n n c c a _;o V_ (966/275-3772) www.fDOC.ca.FoV Statement of Organization lReclpient committee - INSTRUCTIONS ON REVERSE Pape 2 COMMITTEE NAME Revitalize San Rafael Libraries & Community Center: Ad Committee's Top Funder San Rafael Public Library Foundation I.D. NUMBER 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) AUTHORIZED TO OBTAIN BANK RECORDS AREA CODE/PHONE BANKACCOUNT NUMBER Bank of Marin 415-485-2265 ADDRESS OF FINANCIAL INSTITUTION CITY STATE ZIP CODE 1101 Fourth 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 DISTRICTNUMBER IF APPLICABLE) ELECTION CHECKONE Nonpartlsan Partisan (I%t POW'MI Party oelPw) Nonpartsan Partisan (list Pon-1 parry Pelowl Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATES) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(5) OFFICE SOUGHT OR HELD OR MEA5URE(S) JURISDICTION IF A RFCAI I _STATF "RFCAI [-IN FRONT OF THE OFFICEHOLDER'S NAME (INCLUDE DISTRICT NO, CITY OR COUNTY, AS APPLICABLEI CHECK ONE San Rafael Public Libraries and Community Center Initiative Marin County, San Rafael, CA SUPPOi RT OPPOSE SUPPORT OPPOSE FPPC Form 410 (October/2023) FPPC Advice: advicetWfonc.ca.eov (8661275-3772) www.fuoc.ca.eov Statement of Organization Recipient Committee 0 INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D. NL 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 INDUSTRY 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 ❑ awe.�eee S. Terinination Requirements By sJgrung the Verification, the treasurer, assistant treasurer anclJor candidate, officeholder, or ponent certify 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: advite6favc.mirov 1866/2753772) www.f00c.c3.[av