HomeMy WebLinkAboutForm 410 - Gary Phillips for Mayor 2011 TerminationStatement of Organization
Recipient Committee
Statement Type El Initial
Not yet qualified D or
n Amendment
List I.D. number:
#1339680
If '/
Date qualified as committee Date qualified as committee
(Ifappl—bk,,)
0 Termination — See Part 5
List I.D. number:
# 1339680
0_1 — 31 2013
Me of Termination
Date Stamp
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OFCOMMIIIEE
NAME OF TREASURER
Gary Phillips for Mayor 2011 Richard Kalish
For Official Use Only
STREET ADDRESS(NOPQ BOX)
STREET ADDRESS (NO Ro BOX)
AREA CODE/PFIONE
CITY STATE E ZIP CODE
AREA CODE/PHONE CITY STATE ZIP CODE
San Rafael CA 94901
( San Rafael CA 94901
(
MAILING ADDRESS (IF DIFFERENT)
NAME OF ASSISTANT TREASURER, IF ANY
FAX / E NIAI* AuDREss
STREET ADDRESS (NO PO. BOX)
COUNTY OF DOMICILE
jURISDICTION WHERE COMMITTEE IS ACTIVE CITY STATE ZIP CODE
AREA CODE/PHONE
Marin
San Rafael
NAME OF PRINCIPAL OFFICER(S)
Attach additional information on appropriately labeled continuation sheets. STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE
AREA CODE/PHONE
3. Verification
I have used all reasonable diligence in preparingthis s
tement 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�alifor
iajthat lhe fore goingjis , eoRcl correct.
Executed on 01/31/2013
By
DATE
SIGNATURE 'OF TREASU
EA IIRIIIORAIIIITANTTRIASURER
Executed on .01/31/2013 By
DATE
SIG TUBE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed or,
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 F I& P11, 411
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
Ib. NUMBER
Gary Phillips for Mayor 2011 1339680
* All committees must list the financial institution where the campaign bank account is located.
NAME OP FINANCIALINSHWHON AREA CODC/PHONE - ---TANK ACCOUNT NUMBER
Bank of Marin (415)485-2265 02-341162
ADDRESS CITY STATE ZIP CODE
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.
NAME OF CANDIDATEICIFFICEHOLDERISTATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Primarily Formed Committee
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) NAME 08 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. AS APPLICABLE)
FPPC Form 410 (Dec/2012)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SUPPORT
r-1
OPPOSE
El
SUEEQ91
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FPPC Form 410 (Dec/2012)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov