HomeMy WebLinkAboutForm 410- John Gamblin for City Council 2015 InitialStatement of Organization
Recipient Committee
Statement Type Initial ❑ Amendment
Not yet qualified Aor List I.D. number:
1.
NAME OF COMMITTEE
/ 3 -7 a ?-,
❑ Termination — See Part 5
List I.D. number:
Date qualified as committee Date qualified as committee Date of Termination
(If applicable)
n
Gamblin for City Council 2015
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIPCODE AREACODE/PHONE
San Rafael CA 94903 (
MAILING ADDRESS (IF DIFFERENT)
PO Box 544, Davis, CA 95617
FAX/E MAIL ADORES',
COUNTY OF DOMICILE JURISDICTION WHLRE COMMITTEE IS ACTIVE
Marin I City of San Rafael
Attach additional information on appropriately labeled continuation sheets.
Date Stamp
CEIVED AND FILE
in he office of the Secretary of St(
of the State of California
JUL 0 3 2015
and Delivered,
2. Treasurer and Other Principa
NAME OF TREASURER
For Official Use Only
John P. Fronefield
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
West Sacramento
NAME OF ASSISTANT TREASURER, IF ANY
John Gamblin
CA 95691 (
STREET ADDRESS (NO P.O. BOX)
UTY STATE ZIP CODE AREA COUE/PHONE
San Rafael CA 94903 (
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
3. Verification
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 perju under the laws f the State of Cali forn' h :2;v
rue and correct.
Executed on� By
DATESIGNATURE OF TREASURER OR ASSISTANTTREASU RER
Executed on ois, By - --�?
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
Executed on
DATE
By
SIGNATURE OFCONTROLLING OFFICEHOLDER, CANDIDATE, ORSTATE MEASURE PROPONENT
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
Im
Statement of Organization CALIFORNIA
Recipient Committee ; IT 411
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I.D. NUMBER
Gamblin for City Council 2015
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INS. ITUTION
Wells Fargo Bank
ADDRESS
AREA CODE/PHONE
(916)376-5680
C TY
BANK ACCOUNT NUMBER
STATE ZIP CODE
2140 Town Center Plaza West Sacramento CA 95691
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.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
John Gamblin
San Rafael City Council
2015
® Nonpartisan
SUPPpRT
❑ Nonpartisan
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) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO.. CITY OR COUNTY Ac APPI IrARI FI
FPPC Form 410(Dec/2012)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
El
SUPPpRT
OPPOSE
FPPC Form 410(Dec/2012)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov