HomeMy WebLinkAboutForm 497 - Yes on Measure E (2013-08-29)liq
NAME OF FILER
Committee For A Safer San Rafael - Yes On Measure E
AREA CODE/PHONE NUMBER I.D. NUMBER (Wepplicable)
415-456-4000 1359556
STREET ADDRESS
1000 4th Street Suite 600
CITY STATE
San Rafael CA
n"I
Amounts may be rounded to whole dollars.
Date of
8/29/201
This Filing ----a
Report No,
1-1 Amendment
to Report No.
ZIP CODE (explain below)
94901 No. of Pages
MUTI 10T, . r., W
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONTRIBUTOR
CODE
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
AMOUNT
RECEIVED
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
IND
San Rafael Firefighters P.A.C.
com
9/25/13
ID# 891308
OTH
$5, 000
P.O. Box 2519
PTY
San Rafael, CA 94912
SCC
® Check if Loan
IND
8/26/13
Stephen Mizroch, M.D.
com
Retired
71 Bryn Mawr Dr.
CATH
Physician
$500
San Rafael, CA 94901
PTY
SCC
M Check if Loan
FK� IND
9/25/13
Stephen Mizroch, M.D.
com
Retired
71 Bryn Mawr Dr.
OTIC
Physician
$500
San Rafael, CA 94901
PTY
I
SCC
Check if Loan
kContributor Codes
IND — Individual PTY — Political Party
COM — Recipient Committee (other than PTY or SCC) SCC — Small Contributor Committef
OTH — Other
Reason for Amendment:
FPPC Form 497 (Jan103)
FPPC Toll -Free Helpline: `s• .•
866/275-3772