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Home My WebLink AboutForm 460 - Marc Levine for City Council 2013 (2012-12-12) TerminationRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers periodI Date of election if applicable 7/1112 (Month, Day, Year) from through 12112/12 W Date Stamp COVER PAGE Page 1 of �,n For Official Use Only 1. Type of Recipient Committee: All Committees—Complete Parts 1, 2, 3, and 4. 2. Type of Statement: ® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement 0 State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd -Year Report ❑ Recall ❑ Controlled ® Termination Statement ❑ Supplemental Preelection (Also complete Part 5) 0 Sponsored Also file a Form 410 Termination ( ) Statement - Attach Form 495 ❑ General Purpose Committee [Also Complete Fart B) ❑ Amendment (Explain below) 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee --- ❑ Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I I.D. NUMBER 131 .3 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Marc Levine for City Council 2013 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX l E-MAIL ADDRESS Treasurer(s) NAME OF TREASURER Bruce Raful MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE San Anselmo CA 94960 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE,'PHONE OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in th under penalty of perjury under the laws of the State of California that the foregoing is true and correct. t` 12/12112 Executed on By Date - 3° Signature of?reasur( atant Treasurer AAExecuted on 12112/12 By j L Date Scna£ure efCc : r -Nina Officeha., der_ Catdtlate. State Measure Procon€ent gs Rescoi Executed on By Date SiI;rkature o'Ccntrcgmg 0`f,ceho:der ;vardsciate. State Measure Proponent is true and complete. I certify Executed on By Dole Signature of ContrCli ng Gfncenclder, Candidate. State Measure Proponent FPPC Form 460 (Januaryt05} FPPC Toll -Free Helpline: 8661ASK-FPPC (8661276.3772) State of California Recipient Committee Campaign Statement Cover Page — Part 2 S. Officeholder or Candidate Controlled Committee Type or print in ink. NAME OF OFFICEHOLDER OR CANDIDATE Marc Levine OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) San Rafael City Council Member RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael CA 94901 Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER Levine for Assembly 2012 1339058 NAME OF TREASURER CONTROLLED COMMITTEE? Bruce Raful ® YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE San Rafael CA 94901 415-533-1445 COMMITTEE NAME I.D. NUMBER Friends of Marc Levine for Assembly 2014 1353695 NAME OF TREASURER CONTROLLED COMMITTEE? Bruce Raful ij YES ❑ No COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE San Rafael CA 94901 415-533-1445 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE COVER PAGE - PART 2 Page 2 of BALLOT NO. OR LETTERI JURISDICTION I ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (Januaryi05) FPPG Toil -Free Helpline: 866/ASK-FPPG (6661275-3772) State of California Campaign Disclosure Statement mcalculate Column a.add Type «rprint mink. ... Schedule E. Line o suMmAnvPAGE Summary Page 8. 8UBTO7ALCAGHPAYMENTS ... ...... —... ... Amounts may be rounded to whole dollars. tat.m.nt covers period F s CALIFORNIA 460 10.Nonmonetary Adjustment --............................ —... Schedule C, Line 1iTOTAL EXPENDITURES MADE— ....... ............... —'AdmLmo o~v~m a period amounts. nthis ia the first report being filed 0 from 7/1/12 FORM 0a ny> U ------ through 12/12/12 Page 3, of 6 I SEE INSTRUCTIONS ON REVERSE NAME oF FILER I.D.NUMBER Marc Levine for City Council 2013 131 aW13�e Contributions Received Column A Column B Calendar Year Summary for Candidates TOTAL THIS PERIOD �FROMATTACHEO SCHEDULES) CALENDAR YEAR TOTALTODATE Running in Both the State Primary and 21. Expenditures Expenditures Made mcalculate Column a.add 0. Payments Made ............. .................. ---......... ... Schedule E. Line o 7. LomnsMade---------------- ----. Schedule H, Line 8. 8UBTO7ALCAGHPAYMENTS ... ...... —... ... ................ Add Lines o~r $ Fi Accrued Expenses (Unpaid Bills) --......................... Schedule F Line 10.Nonmonetary Adjustment --............................ —... Schedule C, Line 1iTOTAL EXPENDITURES MADE— ....... ............... —'AdmLmo o~v~m a Current Cash Statement 12.Beginning Cash Bdence-------' Previous Summary Page, Line /o S 13.Cash Receipts ................ ....... .... ..... ...... ...... Column ^ Line aabove 14. MisceUaneous|noreaaootoCaeh--------— Schedule 1,Line v 15.Cash Payments .... --....... ---............. ..... Column A.Line oabove 10.ENDING CASH BALANCE. ........ Add Lines o~,a~wthen subtract Ltne/a o nthis isatermination statement, Line /omust be zero. Cash Equivalents and Outstanding Debts 10. CaahEqukelento-------------� See instructions n"reverse $ 1279.01 2597.11 0 269711 O 0 25Q7]1 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Mmu*^ (if v"w"ctmVoluntary Expenditure Limit) Date v/Election Total mDate (mmmu0v) | a__--____ | Amounts in this section may be different from amounts reported in Column B. FPPC Form wm(JanuaryiO5) FppcToll-Free xalpone:uoomaKfppo(uo»z/5-arro) mcalculate Column a.add 'vv amounts mColumn xmthe corresponding amounts from Column amyour last -' - 210011 report. Some amounts m Column Amay oenegative v figures that should be oumramou from previous period amounts. nthis ia the first report being filed 0 for this calendar year, only cmvv over the amounts from Lines 2.T.and n(if ------ 0a ny> U ------ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Mmu*^ (if v"w"ctmVoluntary Expenditure Limit) Date v/Election Total mDate (mmmu0v) | a__--____ | Amounts in this section may be different from amounts reported in Column B. FPPC Form wm(JanuaryiO5) FppcToll-Free xalpone:uoomaKfppo(uo»z/5-arro) Schedule A . Type v,print in mx SCHEDULE Monetary Contributions Received °moumsmav be munovo Statement covers period CALIFORNIA to whole dollars. 460 from 7/1/12 FORM 4 12/12/12 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D.NUMBER Marc Levine for City Council 2013 13 1 AM 31 DATE FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) CA Grocers Association Political Action E] IND W] COM 760914 7/2/12 700 700 Sacramento CA 95814 E] PTY El ScC F1 IND El COM E] CITH E] PTY El SCC F] IND El COM E] OTH Ej PTY El ScC F] IND com OTH E] PTY scC IND El COM r] CITH SUBTOTAL$ 700 Schedule Summary 1.Amount received this period - itemized monetary contributions. 2. Amount received this period - uniternized monetary contributions of less than $100 _.. 3. Total monetary contributions received this period, (Add Lines 1 and 2, Enter here and on the Summary Page, Column A. Line 1.) ... 9 WE � � TOTAL $ 700 *Contributor Codes IND -Individual COM - Recipient Committee (other than PTY o,SCC) or* - Other (ag_ business entity) pTv-pom/ua|Panty SCC - Small Contributor Committee FppcForm voupanuaryms pppnToll-Free Helpline: nsomSn-Fppo(8anmro-3rr2) Schedule E Type or print in ink. Statement covers period Amounts may be rounded Payments Made to whole dollars. from 7/1/12 SEE INSTRUCTIONS ON REVERSE NXMEOF FILER Marc Levine for City Council 2013 through 12/12/12 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Page 5 of I.D. NUMBER 1313W 3 S CNP campaign paraphernalia/mise. MBR member communications RAD radio airtime and production costs CNS campaign consultants NTTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads UVEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE IIF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Terrapin Crossroads San Rafael CA 94901 "Thank you" party 2024.11 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 2024.11 Schedule E Summary 1. Itemized payments made this period. include all Schedule E subtotals. 2024.11 2. Unitemized payments made this period of under $100.................................................................... 85 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ................ .. $ 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page. Column A, Line 6.) ............................. TOTAL $ 2109.11 FPPC Form 460 (January/05) FPPG Toll -Free Helpline: 866/ASl4FPPC (8661275-3772) Schedule I � Miscellaneous ��vrn�mmm� ____� ��*�m/e/ '�to whole dollars. 60from 7/1/12 FORM 6SEE Page - ofNAME INSTRUCTIONS ON REVERSE 12112112 through OF FILERI.D. NUMBERMarc Levine for City Council 2013 131 OW <S3DATEFULL NAME AND ADDRESS OF SOURCE DESCRIPTION OF RECEIPT AMOUNTOFRECEIVED (IF COMMITTEE, ALSO ENTER LD, NUMBER) INCREASE TO CASH Attach additional information ooappropriately labeled continuation sheets. Schedule I Summary 1.Itemized increases to cash this period. .......... —....... ............ ............... —....... .......................... ........... ...... —$ 2.Unhnmbedincreases to cash of under 81OOthis period .......... —......... ___ ......... ------....... ........ ----'$ 3. Total of all interest received this period on loans mode to others. (Schedule H. Column (e)j -----------� 4, lobs| miscellaneous increases to cash this period. (Add Lines 1. 2. and 3. Enter here and on the SVBTOTALs 130,10 0 130.10 FPPCForm wm(January/05) pPPcToll-Free *elpme:nosmnx-Fppo(oamur5-3rru)