No preview available
HomeMy WebLinkAboutForm 410- Gary Phillips for Mayor 2015 AmendmentStatement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or Date qualified as committee 1. Committee Information NAME OF COMMITTEE Gary Phillips for Mayor 2015 © Amendment List I.D. number: 1376443 04 /13 /2015 Date qualified as committee (If applicable) ❑ Termination — See Part 5 List I.D. number: f� Date of Termination STREETADDRESS(NO PO BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 ( MAILING ADDRESS (IF DIFFERENT) FAX / E-MAIL ADDRESS COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Marin I San Rafael Attach additional information on appropriately labeled continuation sheets. Rleteived MAY 1 1 2015 Time: C,ty Clerk's Offlic City of San Rafael For Official Use Only 2. Treasurer and Other Principal Officers NAME OF TREASURER Richard Kalish STREET ADDRESS (NO P.O. BOX) CITY STATE San Rafael CA ZIP CODE 94901 AREA CODE/PHONE ( NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO PO BOX) CITY STATE ZIP CODE AREA CODE/PHONE NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P D. $0M CITY STATE 2IP CODE AREA CODE/PHONE 3. Verification I have used all reasonable diligence in preparin tatement 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 Stat of C Iforni hat th regoin tru nd�ct. Executed on 05/11/2015 By DATE =IGNATURER OR ASSISTANT TREASURER Executed on 05/11 /2015 By DATE SIGNATLZAE OF CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT Executed on By f 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(Dec/2012) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization CALIFORNIA' Recipient Committee • - INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I D. NUMBER Gary Phillips for Mayor 2015 1376443 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER Bank of Marin (415)485-2265 ADDRESS CITY STATE ZIP CODE 1101 Fourth Street San Rafael CA 94901 4. Type of Committee Complete the applicable sections. • 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." • 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 NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Gary Phillips Mayor, City of San Rafael 2015 ® Nonpartisan 5U[n ❑ Nonpartisan Primarily Formed Committee 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 N0. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO , CITY OR COUNTY, AS APPLICABLE) CHECK ONE FPPCForm 410(Dec/2012) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SUPPORT OPPOSE 5U[n OPPOSE FPPCForm 410(Dec/2012) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization CALIFORNIA1 Recipient Committee • - INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME D NUMBER Gary Phillips for Mayor 2015 1376443 4. Type of Committee (Continued) 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 STR6 LT CiTY .5TATF ZIP COBE Date qua li l i �d S. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the 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 (Dec/2012) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov