No preview available
HomeMy WebLinkAboutForm 460 - Police Association PAC (2011-12-31)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Type or print in ink. Statement covers period from 10/23/2011 SEE INSTRUCTIONS ON REVERSE I through 12/31/2011 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee O State Candidate Election Committee 0 Recall (Also Complete Part 5) 0 General Purpose Committee ® Sponsored ❑ Small Contributor Committee O Political Party/Central Committee 3. Committee Information COMMITTEE NAME (OR CANDIDA ❑ Primarily Formed Ballot Measure Committee Q Controlled O Sponsored (Also Complete Part 6) ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) I.D. NUMBER IF NO COMMITTEE) Sar. Rafael Police Association Political Action Committee STREET ADDRESS (NO P.O. BOX) 1520 Fifth Avenue CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 (415) 485-3000 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX P.O. Box 151557 CITY STATE ZIP CODE AREA CODE/PHONE San Rafael. CA 94915-1557 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 k under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 01/31/2012 Date Executed on Date Executed on Date Executed on Date www.neffile.com By By Date of election if applicable: (Month, Day, Year) Date Stamp 2. Type of Statement: ❑ Preelection Statement ® Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Mr. Scott Inqels MAILING ADDRESS COVER PAGE Page 1 of 41 For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement - Attach Form 495 1520 Fifth Avenue CITY STATE ZIP CODE AREA CODE/PHONE San Rafael, CA 94901 (415) 485-3000 NAME OF ASSISTANT TREASURER, IF ANY MS- Rtacy F.. Owens MAILING ADDRESS 5940 College Avenue CITY STATE ZIP CODE AREA CODE/PHONE Oakland. CA 94618 f-Inl C;;2-71nnn OPTIONAL: FAX I E-MAIL ADDRESS ined herein and in the attached schedules is true and complete. I certify By Signature of Controlling Otr, ehotder, Candidate, State Measure Proponent By Signature of Controltnna Officeholder- Candidate, Sate Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) State of California Type or print in ink. COVER PAGE - PART 2 Recipient Committee CALIFORNIA °1I Campaign Statement FORM ' Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 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 NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) Page 2 of 41 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE 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 officeholders) or candidates) 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 CITY STATE ZIP CODE AREA CODEIPHONE Attach continuation sheets if necessary FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275.3772) State of Califomia www.netfile.com Campaign Disclosure Statement Type or print in ink. Amounts may be rounded Summary Page to Whole dollars. Statement covers period from 10/23/2011 SUMMARY PAGE SEE INSTRUCTIONS ON REVERSE through 12/31/2011 Page 3 of 41 NAME OF FILER I.D_ NUMBER San Rafael Police Association Political Action Committee 831553 Contributions Received Column TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 9,772.00 Schedule E, Line 4 $ 2, Loans Received...................................................... Schedule B, Line 3 ........... Schedule H, Line 3 0.00 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add unes 1 +2 $ 9,772.00 4. Nonmonetary Contributions .................................... Schedule C, Line 2,588.09 Schedule C, Line 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3+4 $ 12,360.09 2,310.81 Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 $ 2.00 7. Loans Made.. .................. ...... ....... ....... ........... Schedule H, Line 3 0.00 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ 2.00 9. Accrued Expenses (Unpaid Bills) ................... ........... . Schedule FLine 3 -279.28 10. Nonmonetary Adjustment .......................................... Schedule C, Line 2,S88.09 11. TOTAL EXPENDITURES MADE ....... ......... .......... ......Add Lines +9+10 $ 2,310.81 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 9,446.88 13. Cash Receipts ................................................... Column A, Line 3above 9,772.00 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 0.21 15. Cash Payments... .............. ........................... Column A, Line 6 above 2.00 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 19,219,09 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Parte $ 0.00 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 0.00 19. Outstanding Debts ......................... Add Line 2+Line 9inColumn 6above $ 27 282.00 www.netfiie.com Column S CALENDAR YEAR TOTALTO DATE $ 46,302.00 $ 46,302.00 3,715.82 $ 50,017.82 $ 29,353.71 0.00 $ 29,353.71 27.282.00 3.715.82 $ 60,351.53 To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year. only carry over the amounts from Lines 2, 7, and 9 (if any). Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6130 711 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mmldd/yy) I1 $ IJ $ *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Ar-hafill lip A Type or print in ink. SCHEDULE A Amounts may be rounded Monetary Contributions Received Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 4 of 41 SEE INSTRUCTIONS ON REVERSE 'NAME OF FILER I.D.NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE (IF COMMITTEE, ALSO ENTER Io. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC, 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Elisha Adams IND Police Officer 61.85 557.41 []COM C/o: San Rafael Police Association E] OTH City of San Rafael 1520 Fifth Avenue ❑PTY San Rafael, CA 94901 C Union member's dues received through intermediaivXAN Rafael Police Association, 152C Fifth Avenue, S n Rafael, CA 94901 12/20/2011 Elisha Adams EIIND Police Officer 61.8S 557.41 EICOM C/o: San Rafael Police Association R OTH City of San Rafael 1520 Fifth Avenue 0 PTY San Rafael, CA 94901 E4SCCR Union member's dues received through intermedia iv: an afaEl Police Association, 152C Fifth Avenue. San Rafael, CA 9494 12/20/2011 Raul Aguilar BIND Police Officer 61.85 557.41 RCOM I C/o: San Rafael Police Association ❑ OTH City of San Rafael 1520 Fifth Avenue PTY San Rafael, CA 94901 Union member's dues received through intermedia iy:Q�afaEl Police Association, 152C Fifth Avenue, San Rafael, CA 949C1 12/20/2()11 Raul Aguilar BIND Police Officer 61.85 557.41 r'COM C/o: San Rafael Police Association ❑ OTH City of San Rafael I520 Fifth Avenue PTY San Rafael, CA 94901 Union member's dues received through intermedia jy:Q§qCRafaEl Police Association, 152C Fifth Avenue, San Rafael, CA 949011 12/20/2011 Anthony Augustyn RIND Police Officer 61,85 557.41� [:]COM C/o: San Rafael Police Association Ej OTH City of San Rafael Fifth Avenue ❑ PTY Rafael, CA 94901 Union member's dues received throuQh interm-dia4y:1APCP,-f-dl Police Association, IS2j Fifth Avenue, Sin Rafael, CA 94901,11 SUBTOTAL$ 309.25 Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.) ......... ....... ............ ........ ___ ...... ___ ............. _ .......... $ 9,772.00 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.) 0.00 TOTAL $ 9,772.00 *Contributor Codes IND -individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA_ to whole dollars. / M from 10/23/2011 through 12/31/2011 Page 5 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FCOMMITTEE.ALSOENTERLD.NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE * { IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 thony Augustyn BIND Police Officer 61.85 557.41 ❑ COM C/o: San Rafael Police Association OTH 1520 Fifth Avenue E] PTY City of San Rafael San Rafael, CA 94901 Rafa nion member's due received through intermedia an Police Association. 1520 Fifth Avenue San Rafael A 9490 22%20/2011 Blair Auld BIND Police Officer 61.85 557.41 ❑ COM C/o: San Rafael Police Association F-1 OTH 1520 Fifth Avenue PTY City of San Rafael San Rafael, CA 94901 (�j Union member's dues received throw h intermedia :`'San(; I2afae Police Association 1520 Fifth Avenue San Rafael CA 9490 12/20J2011 Blair Auld �xIND Police Officer 61.85 557.41 ❑ COM C/o: San Rafael Police Association E] OTH 1520 Fifth Avenue Y PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermediary:�an � afael Police Association 1520 Fifth Avenue San Rafael CA 9490 12/20/2011 Valerie Avalon QX IND 61.84 123.68 ❑ COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue El PTY San Rafael, CA 94901 )'') [; Union member's dues received through intermedia :`J* n afael Police Association, 1520 Fifth Avenue, S n Rafael, CA 9490 12/20/2011 Valerie Avalon BIND 61.84 123.68 ❑ COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue F_� PTY San Rafael, CA 94901 Union member's dues received throu h intermedia r�{^{l .'3 1Y`Rafae Police Association 1520 Fifth Avenue S�n Rafael CA 949011 *Contributor Codes IND—individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.neffle.com SUBTOTAL$ 309.23 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 6 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE (IF COMMITTEE, ALSO ENTER I D NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAM E PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 James Bellamy Rx IND Police Officer 61.85 557.41 [-]COM C/o: San Rafael Police Association E]OTH 1520 Fifth Avenue Ej PTY City of San Rafael San Rafael, CA 94901 Union member' dues received through intermedia xv:qa:CRafael Police Association. 1520 Fifth Avenue. San Rafael. CA 9490 12/20/2011 James Bellamy Rx IND Police Officer 61.85 557,41 [:]COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael-, CA 94901 -member's mediaiv:qa:CCRafael Police Association, 1520 Fifth Avenue. San Rafael, CA 9490L -Union 12/20/2011 Todd Berringer Rx IND Police Officer 61.85 557-41 EICOM C/o; San Rafael Police Association [_]OTH 1520 Fifth Avenue ❑City PTY of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia iv:qanC(12afael Police Association, I520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Todd Berringer [E IND Police Officer 61.85 557.41 [-]COM C/o: San Rafael Police Association ❑ OTH City of San Rafael 1520 Fifth Avenue ❑ PTY San Rafael, CA 94901 Union member's dues received through intermedia xy:qasnc�z.f.el Police Association, 15201 Fifth Avenue, Sin Rafael, CA 9490 12/20/2011 Geoffrey Bowker RIND Police Officer 61.85 557.41 F] COM C/o: San Rafael Police Association ❑ OTH Citv of San Rafael 1,520 Fifth Avenue ❑ PTY San Rafael, CA 94901 IUnion member's dues rece-4vtd_throuqh intermedia 33 Police Association, 15201 Fifth Avenue, SAn Rafael, CA 9490r, *Contributor Codes IND- Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee www.nettile.com SUBTOTAIL$ 309.25 [_ I FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period . to whole dollars. / from 10/2312011 • through 12/31/2011 Page 7 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12J20j2011 eoffrey Bowker RIND Police Officer 61.85 557.41 ❑ COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 j(��j Union member's dues received thr u h into media : San Rafae Police Association 1520 Fifth Avenue San Rafael CA 94901 12/20/2 011 Lynne Bracken X IND Police Officer 61.84 123.68 ❑ COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia :�an Rafae Police Association 1520 Fifth Avenue San Rafael CA 9490 12/20j2011 Lynne Bracken ❑X IND Police Officer 61.84 123-68 [-]COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑PTY City of San Rafael San Rafael, CA 94901 ((�� Union member's dues received through intermedia :`-San �(� 2afae Police Association 1520 Fifth Avenue S n Rafael CA 9490 12/20/2011 Michael Byers ❑x IND Police Officer 61.85 557.41 ❑ COM C/o: San Rafael Police Association ❑ OTH City of San Rafael 1520 Fifth Avenue []PTY San Rafael, CA 94901 n {; Union member's dues received through intermedia :nC 12afae Police Association, 1520 Fifth Avenue, S n Rafael, CA 9496 12%20/2011 Michael Byers ❑X IND Police Officer 61.85 557.41 ❑ COM C1o: San Rafael Police Association ❑ OTH 1 (City of San Rafael 11520 Fifth Avenue ❑ PTY ''tSan Rafael, CA 94901 nI� j WLon member's dues received through intermedia y:�S29Rafae Police Association, 15201 Fifth Avenue, San Rafael, CA 9490 SUBTOTAL$ 309.23 'Contributor Codes IND -individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY- Political Party SCC -Small Contributor Committee www.netfile.com FPPC Form 464 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 8 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE , (IF COMMITTEE, ALSO ENTER ID NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLavED,ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12%20/2011 Shelly Cade X ❑ IND Police Officer 61.85 557.41 ❑ COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑ PTY City Of San Rafael San Rafael, CA 94901 Union member's dues received hrou h intermediaxv:qanCCRafael Police Association, 1520 Fifth Avenue S4. Rafael CA 94901 12/20J2011 Shelly Cade ❑X IND Police Officer 61.85 557.41 [:]COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 n (; nion member's dues received through intermedia :`'San 12afae Police Association 1520 Fifth Avenue San Rafael CA 9490 12/20/2011 Joseph Camins nIND Police Officer 61.85 557.41 ❑ COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue❑ P.�, City of San Rafael San Rafael, CA 94901 Union member's dues received through intermediarv:E;aSnCCRafael Police Association 1520 Fifth Avenue S n Rafael CA 9490 12/20/2011 Joseph Camins XIND Police Officer 61.85 557.41 [:]Com C/o: San Rafael Police Association []OTH City of San Rafael 1520 Fifth Avenue ❑ PTY San Rafael, CA 94901 Union member's dues received through intermedia :�an Rafae Police Association, 1520 Fifth Avenue, S n Rafael, CA 9490 12/20/2011 David Casalnuovo RIND Police Officer 61.85 557.41 ❑ COM C/o: San Rafael Police Association ❑ OTH City of San Rafael ' j 1520 Fifth Avenue ❑ PTY { San Rafael, CA 94901 n Union member's dues received through intermedia -Q afae Police Association 15201 Fifth Avenue SJn Rafael CA 9490 *Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCG) OTH — Other (e.g., business entity) PTY — Political Party SCC —Small Contributor Committee �i.lt�*�**W1TN1t�T•1iC7 SUBTOTAL$ 309.25 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 9 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 David Casalnuovo NIND Police Officer 61.85 557.41 [:]COM C/o: San Rafael Police Association [:1 OTH 1520 Fifth Avenue E] PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia iv:E;aS:CRafael Police Association. 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Allan Castaneda RIND Police Officer 61.85 557.41 [jCOM Clo: San Rafael Police Association F-1 OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 SC�' member's dues received through intermediaiv: an Police Association. 1520 Fifth Avenue, San Rafael, CA 94901 -Union 12/20/2 011 Allan Castaneda -afael _�IND Fx Police officer 61.85 557.41 [-]COM C/o: San Rafael Police Association Ej OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 member's dues received through intermedia :'-San afael qUnion Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Edward Chiu RX IND Police Officer 61.85 557.41 F1COM C/o: San Rafael Police Association EJOTH 3520 Fifth Avenue El PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia iy:qJSrP;afael Police Association, 1520 Fifth Avenue, S Rafael, CA 9490i 12/20/2011 Edward Chiu Fx� IND Police Officer 61.85 557,41 FICOM C/o: San Rafael Police Association [:] OTH City of San Rafael 1520 Fifth Avenue ❑ PTY San Rafael, CA 94901 ,union member's dues received through intermedia &: Q§P(;afae[L Police Association, 15201 Fifth Avenue Sdn Rafael, CA 9490L *Contributor Codes IND -individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC -Small Contributor Committee www.neffile.com SUBTOTAL$ 309.25 1 1 FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statementcovers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 10 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE (IF COMMITTEE, ALSO ENTER 10 NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2 011 R4ck Clary Rx IND Police Officer 61.84 123.68 RCOM C/o: San Rafael Police Association R OTH 1520 Fifth Avenue PTY City of San Rafael San Rafael, CA 94901 [ Upion member's dues received through intermedia iv: ;aSnCCRafael Police 1520 Fifth Avenue n Rafael. CA 9490L 12/20/2011 Rick Clary RIND .Association. Police Officer 61.84 123,68 F] COM C/o: San Rafael Police Association E] OTH 1520 Fifth AvenueCity F] PTY of San Rafael San Rafael, CA 94901 member's dues received throw intermediaiv:[;aSnC Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 9490 —Union 12/20/2011 Robert Cleland Rx IND Police Officer 61.85 I 557.41 ❑ COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 (�afael Union member's dues received through intermediary:`?an Police Association, 1520 Fifth Avenue, San Rafael CA 94901 12/20/2011 Robert Cleland RX IND Police Officer 61.85 557.41 R COM C/o: San Rafael Police Association R OTH 1520 Fifth Avenue PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia xy:qanC(�afae Police Association, 1520 Fifth Avenue, San Rafael-, CA 9490 — 12/20/2011 Christopher Coale Fx� IND IPolice Officer 61.85 557.41 FICOM C/o: San Rafael Police Association F-1 OTH City of San Rafael 1520 Fifth Avenue PTY Sar.❑Rafael, CA 94901 Union member's dues received through intermedia alae Police Association, 1526 Fifth Avenue, SAn Rafael, CA 9490 *Contributor Codes IND—individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.netfile.com SUBTOTAL$ 309,23 1 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule A (Continuation Sheet) Tvve or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 11 Of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME PERIOD (JW 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Christopher Coale RIND Police Officer 61.85 557.41 []COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermed1aiv:qaS:CCRafael Police Association. 1520 Fifth Avenue. San Rafael. CA 9490L 12/20/2011 Lori Coen RIND Police Officer 61.65 557.41 r1COM C/o; San Rafael Police Association ROTH 1520 Fifth Avenue El PTY City of San Rafael San Rafael, CA 94901 On iediaxy:qanCRafael Police Association. 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Lori Coen Rx IND Police Officer 61.85 557.41 RCOM C/o: San Rafael Police Association [:]OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 C Union member's dues received through intermediaxv:Q_aSnC 72afael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Eric Cogbill RX IND Police Officer 61.85 557.41 RCOM C/o: San Rafael Police Association❑ OTH City of San Rafael 1520 Fifth Avenue ❑PTY San Rafael, CA 94901 Union member's dues received through intermediaxy:[AS:C�Z.fael Police Association, 1520 Fifth Avenue, S 4n Rafael, CA 94901 12/20/2011 Eric Cogbill RIND Police officer 61,85 557.41 RCOM C/o: San Rafael Police Association ❑ OTH City of San Rafael 1520 Fifth Avenue ❑ PTY San Rafael, CA 94901 Union member's dues received through intermediaiJy:Q§P;�afae[l Police Association, 1520 Fifth Avenue, SL Rafael, CA 9490lL *Contributor Codes IND—individual COM — Recipient Committee (other than PTY or SCC) OTH — Other ( ' e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.netfi7le.com SUBTOTAL$ 309.25 1 1 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FO M through 12/31/2011 Page 12 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION (IF COMMITTEE, ALSO ENTER 10 NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JW 1 -DEC. 31) (IF REQUIRED) F BUSINESS) 12/20/2011 Ryan Cogbill Fx� IND Police Officer 61.85 557.41 ncom C/o: San Rafael Police Association nOTH I620 Fifth Avenue n PTY City of San Rafael San Rafael, CA 94901 qSCC Union member's dues received through intermedia rv: an Rafael Police Association, 1520 Fifth Avenue. Sn Rafael, CA 9490 12/20/2011 Ryan Cogbill nx IND Police Officer 61.85 557.41 FICOM C/o: San Rafael Police Association nOTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901C Union member's dues received through intermediaxv:q.SnC Rafael Police Association. 1520 Fifth Avenue. Sin Rafael, CA 94901 12/20/2 011 Thomas Collins nx IND Police Officer 61.85 557,41 FICOM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑City PTY of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia rv:qanCrRafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2 oil Thomas Collins nx IND Police Officer 61.85 557.41 [:]COM C/o: San Rafael Police Association []OTH City of San Rafael -520 Fifth Avenue n PTY San Rafael, CA 94901 Union member's dues received through intermedia ry:qanNafael Police Association, 1520 Fifth Avenue, S�'n Rafael, CA 9490 — 12/20/2011 4-tonette Cook RIND Police officer 61.85 557.41 ❑ COM C/o: San Rafael Police Association E] OTH City of San Rafael 1520 Fifth Avenue ❑ PTY San Rafael, CA 94901 Union member's dues received tbX�p�intermediaily:Q§i?(;afaerL Police Association, 15201 Fifth Avenue, S�. Rafael, CA 9490V- *Contributor Codes IND— Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee r"71"11TIMUM 0=11 SUBTOTAIL$ 309,25 1 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 13 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. I -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Antonette Cook ❑IND Police officer 61.85 557.41 ❑ Com CIO: San Rafael Police Association [] OTH 1520 Fifth Avenue F -I PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia xv:qanCCRafael Police 'Association, I520 Fifth Avenue. San Rafael. CA 94901 12/20/2011 Jaime Correa CX, Police officer 61.85 557.41 [] COM C/o: San Rafael Police Association El OTH 1520 Fifth Avenue r-1 PTY City of San Rafael San Rafael, CA 94901 E;SC(� Union member's dues received through intermediarv: an afael Police Association, 1520 Fifth Avenue. S Rafael, CA 9490L 12/20/2011 Jaime Correa Fx� IND Police Officer 61.85 557-41 [:] COM C/o: San Rafael Police Association DOTH 1520 Fifth Avenue ❑City PTY of San Rafael San Rafael, CA 94901 Union member's dues received through intermedin xv: qaSPRafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2 011 David Cron BIND Police officer 61.85 557.41 MCOM CIO: San Rafael Police Association [] OTH City of San Rafael 1520 Fifth Avenue F� PTY San Rafael, CA 94901 Union member's dues received through intermedia ry:qaP(�afaeR Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 David Cron IND Police Officer 61.85 557.41 [-] COM CIO: San Rafael Police Association [:] OTH City of San Rafael 1520 Fifth Avenue F-1 PTY San Rafael, CA 94901 jUnion member's dues received throuqh intermediaily;Q§P(�afae" Police Association, 1520 Fifth Avenue, S n Rafael, CA 9490L *Contributor Codes IND—individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.netfile.com SUBTOTAL$ 309.125 1 FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 14 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER It. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN- 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Ryan De Marta RIND Police officer 61.85 557.41 [:] COM C/o: San Rafael Police Association F-1 OTH 1520 Fifth Avenue n PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intgrmediaxv:qaSnCCRafael Police Association, 1520 Fifth Avenue. San Rafael. CA 94901 12/20/2011 Ryan De Marta ©IND Police Officer 61.85 557.41 El COM C/o: San Rafael Police Association F-1 OTH 1520 Fifth AvenueCity El PTY of San Rafael San Rafael, CA 94901 Union member's dues received�ediaiv:qa:CCRafael Police —Association 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Christian Diaz FX IND Police officer 61,85 557.41 []COM Clo: San Rafael Police Association ❑ OTH 1520 Fifth Avenue F� PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia iv:qa:CCRafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Christian Diaz FRI IND Police Officer 61.85 557.41 DCOM C/o: San Rafael Police Association E] OTH City of San Rafael 1520 Fifth Avenue D PTY San R.f..! , CA 94901 Union member's dues received through intermedia iy:qanCCZafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Christopher Duncan MX IND Police officer 61.85 557.41 [:JCOM C/o: San Rafael Police Association E]OTH City of San Rafael 1520 Fifth Avenue ❑ PTY San Rafael, CA 94901 Union me edia�V:Q§P�afaei]L Police Association, 1520 Fifth Avenue. S Rafael, CA 9490L *Contributor Codes IND— Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.netfile.com SUBTOTAL$ 309.25 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661276-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 15 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED.ENTER NAME PERIOD (JAN- I -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Christopher Duncan IND Police Officer 61.85 557.41 [:]COM C/o: San Rafael Police Association El OTH 1520 Fifth AvenueCity El PTY of San Rafael San Rafael, CA 94901 Union member's dues received through intermediaiv:qaS:CCRafael Police Association, 1520 Fifth Avenue, S Rafael. CA 94901 12/20/2011 Scott Eberle Mx IND Police Officer 61.85 557,41 MCOM C/o: San Rafael Police Association MOTH 1520 Fifth AvenueCity El PTY of San Rafael San Rafael, CA 94901 union member's dues received through intermedia iv­:E;a:CCZafael Police Association. 1520 Fifth Avenue. San Rafael, CA 94901 12/20/2011 Scott Eberle HIND Police Officer 61,85 557,41 E]COM C/o: San Rafael Police Association El OTH 1520 Fifth Avenue E] PTY City of San Rafael San Rafael, CA 94901 nion member's dues received through intermediaiv:qan SIC CRafael Police Association, 1520 Fifth Avenue Rafael CA 9490L 12/20/2011 Daniel Fink RIND Police Officer 61.85 557.41 ❑Com I C/o: San Rafael Police Association [:] OTH City of San Rafael 1120 Fifth Avenue M PTY San Rafael, CA 94901 nion member's dues received through intermedia xy:qaP�af..11 Police Association, 1520 Fifth Avenue, S n Rafael, CA 9490 1 12/20/2011 Daniel Fink Mx IND Police officer 61.85 j 557,41 [:]COM C/o: San Rafael Police Association ❑ OTH City of San Rafael 1520 Fifth Avenue PTY San Rafael, CA 94901 jUnion member's dues received throuch intermedia nv:Q29CPafael Police Association, 1520 Fifth Avenue, S�n Rafael, CA 9490[L SUBTOTAL$ 309_25 *Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.netfile.com FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period I A to whole dollars. from 10/23/2011 • through 12/31/2011 page 16 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Jeffrey Franzini ❑ IND Police Officer 61-85 557.41 RCOM C/o: San Rafael Police Association r_jOTH 1520 Fifth Avenue R PTY ❑ City of San Rafael San Rafael, CA 94901 C Union member's dues received through int ermediaiv: anqSC Rafael Police Association, 1520 Fifth Avenue. San Rafael. CA 9490L 12/20/2011 Jeffrey Franzini Rx IND Police Officer 61.85 557.41 RCOM C/o: San Rafael Police Association ROTH 1520 Fifth Avenue R PTY City of San Rafael San Rafael, CA 94901 union member's dues received through intermediaiv: qSCC an Rafael Police Association. 1520 Fifth Avenue, San Rafael. CA 94901 12/20/2011 Just in Graham FRI IND Police officer 61.85 557-41 EICOM C/o: San Rafael Police AssociationH DOT 1520 Fifth Avenue 0 PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia iv:q.S.Nafael Police Association, 1520 Fifth Avenue, Sin Rafael, CA 94901 — 12/20/2011 Justin Graham Fxj IND Police Officer 61�85 557,41 RCOM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 Union member's dues received throe intermedia iy:q.S,CRafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Julie Griffith Z IND Police officer 61.85 557.41 RCOM C/o: San Rafael Police Association El OTH City of San Rafael 1520 Fifth Avenue ❑ PTY San Rafael, CA 94901 jUnion member's dues received through intermedia ny:Q§PCRafaell Police Association, 15201 Fifth Avenue, S n Rafael, CA 9490L *Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g,, business entity) PTY — Political Party SCC; —Small Contributor Committee www.netrile.com SUBTOTAL$ 309.25 1 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 17 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE. ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JW 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Julie Griffith nx IND Police Officer 61.85 557.41 ncom C/o: San Rafael Police Association nOTH 1520 Fifth Avenue n PTY City of San Rafael San Rafael, CA 94901 union member's dues received through intermedianv:qa CSnC Rafael Police Association, 1520 Fifth Avenue. San Rafael. CA 94901 12/20/2011 Lori Hendricks nx IND Police Officer 61.85 557,41 r-1COM C/o: San Rafael Police Association nOTH 520 Fifth Avenue PTY City of San Rafael San Rafael, CA 94901 member'intermediav:aSnCCRafael qnion Police Association 1520 Fifth Avenue. San Rafael, CA 94901 12/20/2 011 Lori Hendricks nx IND Police Officer 61.85 557.41 nCOM C/o: San Rafael Police Association FIOTH 1520 Fifth Avenue n PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia iv:qaSnCCZafae1 Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Robert Henkle nx IND Police Officer 61.85 557.41 ncom C/o: San Rafael Police Association E] OTH City of San Rafael 1520 Fifth Avenue n PTY San Rafael, CA 94901 Union member's dues received through intermedia :`fan Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Robert Renkle nX IND Police Officer 61.85 557.41 DCOM C/o: San Rafael Police Association DOTH City of San Rafael 1520 Fifth Aven:ue F1 PTY San Rafael, CA 94901 Union member's dues received through intermedin rIy:Q§-Y(;Zafaell Police Association, 1520 Fifth Avenue, San Rafael, CA 94901L *Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC -Small Contributor Committee www.neffile.com SUBTOTAL$ 309.25 FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period I A to whole dollars. from 10/23/2011 • through 12/31/2011 Page 18 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/201-1 J. Alexander Holm Fx� IND Police Officer 61.85 557.41 F­1COM C/o: San Rafael Police Association E]OTH 1520 Fifth AvenueCity El PTY of San Rafael San Rafael, CA 94901 C nion member's dues received through intermedig iv: San Rafael Police Association, 1520 Fifth Avenue, Sin Rafael. CA 94901 12/20/2011 J_ Alexander Holm❑ IND Police Officer 61.85 557,41 DCOM C/o: San Rafael Police Association Fj OTH 1520 Fifth AvenueCity El PTY of San Rafael San Rafael, CA 94901 Union member's dues received throucih intermediaiv:EAS:C'-Rafael Police Association, 1520 Fifth Avenue. San Rafael, CA 9490L 12/20/2011 Lisa Holton ©IND Police Officer 61.85 557,41 EICOM San Rafael Police Association ❑ OTH �C/o: 1520 Fifth Avenue ❑City PTY of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia uv:E;aSnNafael Police Association, 1520 Fifth Avenue, S Rafael, CA 94901 12/20/2011 Lisa Holton 9IND Police Officer 61.85 557.41 FICOM C/o: San Rafael Police Association F-1 OTH City of San Rafael 520 Fifth Avenue ❑PTY ,�an Ra�ael , CA 94901 Union member's dues received through intermediaiy:qaP�afael Police Association, 1520 Fifth Avenue, Sin Rafael, CA 94901 12/20/2011 lyi, H,r,,,,i"n FXI IND Police Officer 61.85 557.41 ncom C/o: San Rafael Police Association DOTH City of San Rafael 1520 Fifth Avenue ❑PT ­y San Rafael, CA 94901 P�Zafael Un intermedia Police Association 152C Fifth Avenue San Rafael, CA 949011 *Contributor Codes IND— Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.neffile.com SUBTOTAL$ 309.25 1 1 1 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received San Rafael Police Association Political Action Committee Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE A (CONT.) Statement covers period from 10/23/2011 through 12/31/2011 1 page 19 of 41 I.D. NUMBER 831553 DATE FULLNAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION (IF COMMITTEE.ALSOENTER I.D.NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2 011 Kyle Hornstein RX IND Police Officer 61.85 557.41 ❑COIM C/o: San Rafael Police Association DOTH 1520 Fifth Avenue ❑City PTY of San Rafael San Rafael, CA 94901 E; SCC Union member's dues received through intermediaiv: an Rafael Police Association, 1520 Fifth Avenue San Rafael, CA 94901 12/20/2011 Carl Huber nx IND Police Officer 61.85 1 557.41 EICOM C/o: San Rafael Police Association MOTH 1520 Fifth Avenue F] PTY City of San Rafael San Rafael, CA 94901 Union member's dues received throw h intermediafv:qaSnCCRafae1 Police Association, 1520 Fifth Avenue. San Rafael, CA 9490 12/20/2011 Carl Huber IND Police Officer 61.85 557.41 ❑ COM C/O: San Rafael Police Association E]OTH 1520 Fifth Avenue F� PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia :`('';an Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 — 12/20/2011 Eric Huct RIND Police Officer 61.85 557.41 R COM C/o: San Rafael Police Association [-] OTH 1120 Fifth Avenue F-1 PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia iy:E;aS:C(�afael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Eric Hoot [ZIND Police Officer 61.85 557,41 EICOM C/o: San Rafael Police Association E]OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 jUnion member's dues received through intermedia �Y:Q§I�afaell Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 *Contributor Codes IND -individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee www.netfile.com SUBTOTAIL$ 309.25 1 1 FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Tvpe or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 20 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER 1.0 NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JW 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Scott Ingels QIND Police Officer 61.85 557.41 [:]Com C/o: San Rafael Police Association [:JOTH 1520 Fifth Avenue F] PTY City of San Rafael San Rafael, CA 94901 C Union member's dues received through intermedlaiv: San Rafael Police Association, 1520 Fifth Avenue. San Rafael. CA 94901 12/20/2011 Scott Ingels Fx_j IND Police Officer 61.85 557.41 DCOM C/o: San Rafael Police Association OTH 1520 Fifth Avenue PTY City of San Rafael San Rafael, CA 94901 Union member's dues received throuqh intermedia iv: qsc�' an afael Police Association, 1520 Fifth Aven_ue-qEn Rafael, CA 94901 12/20/2011 Lynette Keller a IND Police officer 61.85 557.41 ❑ COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth AvenueCity PTY of San Rafael San Rafael, CA 94901 CRafael Union member's dues received through intermedia iv: anqSC Police Association, 1520 Fifth Avenue, San Rafael, CA 9490 12/20/2011 Lynette Keller HIND Police Officer 61.85 557.41 ❑COM C/o: San Rafael Police Association DOTH City of San Rafael 1520 Fifth Avenue F� PTY San Rafael, CA 94901 Union member's dues received through intermediaxy:qaSnC( �afael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Rebecca Kuga [RIND Police officer 61.85 557.41 FICOM C/o; San Rafael Police Association E] OTH City of San Rafael I520 Fifth Avenue F-1 PTY San Rafael, CA 94901 [Union member's dues received _jLh�rouh intermedia x-33 Police Association, 152C Fifth Avenue, San Rafael, CA 949011 *Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee www.neffile.com SUBTOTAL$ 309.25 1 1 1 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. III ul 460 from 10/23/2011 F Q M through 12/31/2011 Page 21 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOROCCUPATION IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION (IF COMMITTEE, ALSO ENTER I.D. NUMBER) AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2 oll Rebecca Kuga Mx IND Police officer 61.85 557.41 F -ICOM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑City PTY of San Rafael San Rafael, CA 94901 Union member's dues received through intermediaiv:qaSnCCRafael Police Association, 1520 Fifth Avenue, San Rafael. CA 94901 12/20/2011 Marc Laplante Fxj IND Police Officer 61,85 557.41 F -ICOM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑PTY City of San Rafael San Rafael, CA 94901 Union member's dues received throw intermediaiv: qSCC an Rafael Police Association 1520 Fifth Avenue. San Rafael, CA 94901 12/20/2011 Marc Laplante MIND Police officer 61.85 557.41 EICOM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue PTY City of San Rafael San Rafael, CA 94901❑ Union member's dues received through intermedia xv:qanCCRafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Kimberly Larkey N IND Police Officer 61.85 557,41 MCOM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia ry:[:AS:C(72afael Police Association, 1520 Fifth Avenue, Sq. Rafael, CA 94901 — 12/20/2011 Kimberly Larkey MX IND Police officer 61.85 557.41 mcom C/o; San. Rafael Police Association [_1 OTH 1520 Fifth Avenue M PTY City of San Rafael ISan Rafael, CA 94901 [Union member's dues received through intermedia vy:Q§P(jafaefl Police Association, 15L20 Fifth Avenue, Sin Rafael, CA 9490E *Contributor Codes IND–individual COM – Recipient Committee (other than PTY or SCC) OTH – Other (e.g., business entity) PTY – Political Party SCC – Small Contributor Committee www.netfile.com SUBTOTAL$ 309.25 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 22 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 ndora Lee Ex] IND Police Officer 61.85 557,41 [:] COM C/o: San Rafael Police Association [] OTH 1520 Fifth Avenue F-1 PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermediaiv: qSCC an Rafael Police Association, 1520 Fifth Avenue. San Rafael. CA 94901 12/20/2011 Anndora Lee [ZIND Police Officer 61.85 557.41 EICOM C/o: San Rafael Police Association F-1 OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 Union member's dues received throw intermedia tv:E;aS:CCRafael Police Association, I520 Fifth Avenue Szn Rafael. CA 94901 12/20/2 oil R-g-lic, Leon HIND Police Officer 61,85 557.41 [:]COM C/o: San Rafael Police Association El OTH 1520 Fifth Avenue PTY City of San Rafael San Rafael, CA 94901 cc Union member's dues received through intermediaiv:E;an Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 R-gelio Leon [K IND Police Officer 61.85 557.41 FICOM C/o: San Rafael Police Association E] OTH City of San Rafael 1520 Fifth Avenue ❑ PTY San Rafael, CA 94901 Union member's dues received through intermedia ry:qaSnC( �afael Police Association, 1520 Fifth Avenue, S Rafael, CA 94901 — 12/20/2011 Kevin Macdougaid RIND Police Officer 61.85 557.41 [:]COM C/o: San Rafael Police Association DOTH City of San Rafael 1520 Fifth Avenue❑PTY San Rafael, CA 94901 [�§P�Zafaell jUnion member's dues received through intermediary: Police Association, 15201 Fifth Avenue, S]. Rafael, CA 94901L *Contributor Codes IND—individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g,, business entity: PTY — Political Party SCC — Small Contributor Committee www.nefft'le.com SUBTOTAL$ 309.25 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period I CALIFORNIA to whole dollars. A -r60 from 10/23/2011 FORM through 12/31/2011 Page 23 of 41 NAME OF �FILER I.D. NUMBER San Rafael Police Association Political Action Committee 8315S3 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JW 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Ke- in Macdougald Rx IND Police Officer 61,85 557.41 RCOM C/o: San Rafael Police Association E]OTH 1520 Fifth Avenue ❑PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia xv:qaSnC9Zafae1 Police Association. 1520 Fifth Avenue. San Rafael. CA 9490 12/20/2011 Robin Mark -White Rx IND Police Officer 61.85 557.41 RCOM C/o: San Rafael Police Association r-1 OTH 1520 Fifth Avenue r-1 PTY City of San Rafael San Rafael, CA 94901 QSCC� Union member's dues received throuch intermediaiv: -an afael Police Association. 1520 Fifth Avenue, San Rafael. CA 9490L 12/20/2011 Robin Mark -White [0 IND Police Officer 61.85 557,41 EICOM C/o: San Rafael Police Association E] OTH 1520 Fifth AvenueCity El PTY of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia iv:qaSnCCRafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Michael Mathis RX IND Police officer 61.85 557,41 [:]COM C/o: San Rafael Police Association R OTH City of San Rafael 1520 Fifth Avenue El PTY San Rafael, CA 94901 Union member's dues received through intermedia iy:q.SC�Zafael Police Association, 1520 Fifth Avenue, S n Rafael, CA 94901 12/20/20-11 Michael Mathis RIND Police Officer 61.85 557.41 RCOM C/o: San Rafael Police Association ❑ OTH City of San Rafael 1520 Fifth Avenue ❑PTY San Rafael, CA 94901 lunion member's dues received through intermediary:5§P;ZafaeFL Police Association, 1526 Fifth Avenue, S Rafael, CA 9490�L *Contributor Codes IND -Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g,, business entity) PTY - Political Party SCC - Small Contributor Committee www.netfile.com SUBTOTAL$ 309.25 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 24 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE (IF COMMITTEE, ALSO ENTER 10 NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JW 1 -DEG 31) (IF REQUIRED) OF BUSINESS) 12/20J2011 Kelly M----1 RIND Police officer 61.85 557.41 [:]COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 qSCC union member's dues received through inter ediaxv: an Rafael Police Association. 1520 Fifth Avenue, San Rafael. CA 94901 12/20/2011 Kelly Mauel RIND Police Officer 61.85 557.41 r-1 COM Inion C/o: San Rafael Police Association ROTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 C member's ediaiv:[;aS.0 Rafael Police Association. 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Glenn Mcelderry RIND Police officer 61.85 557.41 [-]COM C/o: San Rafael Police Association E] OTH 1520 Fifth Avenue E] PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia ivJ;aSnCCRatael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Glenn Mcelderry rx-1 IND Police Officer 61.85 557.41 RCOM C/o: San Rafael Police Association E] OTH City of San Rafael 1520 Fifth Avenue R PTY San Rafael, CA 94901 C Union member's dues received through intermedia ty:EASn zafael Police Association, 1520 Fifth Avenue, S Rafael, CA 94901 12/20/2011 Lisa Mceircy RIND Police officer 61.85 557.36 E] COM Clo: San Rafael Police Association El OTH City of San Rafael I520 Fifth Avenue ❑ PTY San Rafael, CA 94901 Union member's duesreceivedthrough intermedia�y:Q§rYqzafaei1 Police Association, 1520 Fifth Avenue. S1. Rafael, CA 9490E SUBTOTAL$ *Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.netfile.com FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT:) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. / ' from 10/23/2011 • RM through 12/31/2011 Page 25 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE , (IF COMMITTEE, ALSO ENTER I D NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (1F REQUIRED) OF BUSINESS) 12f20/2411 Lisa Mcelroy � X IND Police Officer 61.85 557.36 ❑ COM C,o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermediaiv:qSCiCRafaei Police Association, 1520 Fifth Avenue San Rafael, CA4 0 i2f20/2011 Phillip Melodia ❑X IND Police Officer 61.85 557.36 ❑ COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 C(; Union member's dues received throw h intermedia :E;an �Rafael Police Association 1520 Fifth Avenue S n Rafael CA 9490 12J20j2G11 Phillip Melodia ❑X IND Police Officer 61.85 557.36 [-]COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue❑ Y PTY City of San Rafael San Rafael, CA 94901 ((�� Union member's dues received through intermedia :`-;an Rafae Police Association 1520 Fifth Avenue S n Rafael CA 9490 12/20{2011 Beth Minka XIND Police Officer 61.85 557.36 ❑ COM C/o: San Rafael Police Association ❑ OTH City of San Rafael 1520 Fifth Avenue E] PTY San Rafael, CA 94901 nn Union member's dues received through intermedia :`-fan Rafae Police Association, 1520 Fifth Avenue, S n Rafael, CA 9490 12/20/2011 Beth Minks BIND Police Officer 61.85 557.36 ❑ COM CJo: San Rafael Police Association ❑ OTH City of San Rafael 1520 Fifth AvenueE]PTY San Rafael, CA 94901 Union member's dues received throu h intermedia .remit -33P afae Police Association 1520 Fifth Avenue SAn i Rafael CA 9490 *Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.netfile.com SUBTOTAL$ 309.25 1 T FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period 1! CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 26 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRI UTOR B IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED. ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Jorge Navarro NIND Police Officer 61-85 499.20 [-] COM C/o: San Rafael Police Association E] OTH 1520 Fifth Avenue R PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia xv:qaS:CCRafael Police Association, 1520 Fifth Avenue. San Rafael. CA 94901 12/20/2011 Jorge Navarro[_R IND Police Officer 61.85 499.20 FICOM C/o: San Rafael Police Association MOTH 1520 Fifth Avenue F] PTY City of San Rafael San Rafael, CA 94901 Union member,intermediav:qaSnCCRafael Police Association 1520 Fifth Avenue. San Rafael. CA 94901 12/20/2011 Alexis Nielsen Rx IND Police Officer 61.85 557.35 DCOM C/o: San Rafael Police Association [—I OTH 1520 Fifth Avenue ❑City PTY of San Rafael San Rafael, CA 94901 C Union member's dues received through intermedia :`an Rafael Police Association. 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Alexis Nielsen XIND Police officer 61.85 557.35 FICOM C/o: San Rafael Police Association E]OTH City of San Rafael 1520 Fifth Avenue F� PTY San Rafael, CA 94901 Union member's dues received through intermedia iy:Q_a:C.�Zafael Police Association, 1520 Fifth Avenue, San Rafael, CA 9490.L 12/20/2011 Leslie O'Toole QIND Police officer 61.85 557.35 E]COM C/o: San Rafael Police Association E] OTH City of San Rafael 1520 Fifth Avenue ❑ PTY San Rafael, CA 94901 Union member's dues received through intermedia '3 Police Association, 1520 Fifth Avenue, San Rafael, CA 949011 *Contributor Codes IND— Individual COM — Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee www.netfile.com SUBTOTAL$ 309.25 1 1 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2611 Page 27 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE (IF COMMITTEE, ALSO ENTER I D NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Leslie O'Toole Fx IND Police Officer 61.85 557.35 DCOM C/o: San Rafael Police Association OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermediazv:qaSnCCRafael Police Association, 1520 Fifth Avenue. San Rafael. CA 9490L 12/20/2011 Nicola Pata [Z IND Police Officer 61.85 557.35 OCOM C/o: San Rafael Police Association F1 OTH 1520 Fifth Avenue F1 PTY City of San Rafael San Rafael, CA 94901 Un iediaxv-_qa'nCii1.f.el Police Association, 1520 Fifth _Avenue San Rafael. CA 94901 12/20/2011 Nicola Pate Rx IND Police officer 61.85 557.35 RCOM C/o: San Rafael Police Association OOTH 1520 Fifth Avenue PTY City of San Rafael San Rafael, CA 94901 C Union member's dues received through intermedia i:v: qanC Rafael Police Association, I520 Fifth Avenue S n Rafael, CA 94901 12/20/2 011 Raffaello Pata RX IND Police Officer 61.85 557.35 EICOM C/o: San Rafael Police Association E]OTH City of San Rafael 1520 Fifth Avenue ❑ PTY San Rafael, CA 94901 Union member's dues received through inte media Police Association, I520 Fifth Avenue, n Rafael, CA 94901, 12/20/2011 Raffaello Pata RX IND Police officer 61.85 557,35 RCOM C/o: San Rafael Police Association ❑ OTH City of San Rafael 1520 Fifth Avenue ❑PTY San Rafael, CA 94901 junion member's dues received throu h -_'-termediarv:QW;zafae1l Police Association, 15201 Fifth Avenue San Rafael, CA 9490IL *Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee www.netfile.com SUBTOTAL$ 309.25 1 1 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) Schedule A (Continuation Sheet) Tvve or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. / � from 10/23/2011 • RM through 12/31/2011 Page 28 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DAE I FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OpF RECEIVED THIS CALENDAR YEAR TO RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * SELF-EMPLOYED, OYYED,ENT^ERLNAMER (JAN. 1 -DEC. 31) {IF REQUIRED ) OF BUSINESS) 12/20/2011 Brian Patterson RIND Police Officer 61.85 557.35 ❑ COM C/o: San Rafael Police Association DOTH 1520 Fifth Avenue PTY City of San Rafael San Rafael, CA 94901 nion member's dues received through intermedia : qan Raf e Police Association. 520 Fifth Avenue. San Rafael CA 9490 12/20/2011 Brian Patterson ®IND Police Officer 61.85 557.35 [:]COM C/o: San Rafael Police Association E]OTH 1520 Fifth Avenue PTY City of San Rafael San Rafael, CA 94901 ((�� nion member's dues received throw h ir_termedia :gaSn Rafae Police Association 1520 Fifth Avenue San Rafael CA 9490 12/20/2011 Buffy Paxson rN, IND Police Officer 61.85 557.35 ❑ COM C/o: San Rafael Police Association OTH 1520 Fifth Avenue O PTY City of San Rafael San Rafael, CA 94901 nn (; Union member's dues received through intermedia :`;an �tafae Police Association 1520 Fifth Avenue San Rafael CA 9490 12/20/2011 Buffy Paxson BIND Police Officer 61.85 557.35 ❑ COM C/o: San Rafael Police Association ❑ OTH City of San Rafael 1520 Fifth Avenue El PTY San Rafael, CA 94901 nn {� pion member's dues received through intermedia :`an �2afae Police Association, 1520 Fifth Avenue, San Rafael, CA 9490 12/20/2011 Aaron Piombo [RIND Police Officer 61.85 557.35 ❑ COM C/o: San Rafael Police Association ❑ OTH City of San Rafael 1520 Fifth Avenue G1 PTY San Rafael, CA 94901 Union member's dues received through intermedia (r'��({�� Q_W; afae Police Association 1520 Fifth Avenue S n Rafael CA 9490 SUBTOTAL$ 309.25 *Contributor Codes IND—individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.netfile.com FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded statement covers period CALIFORNIA to whole dollars. 460' from 10/23/2011 FORM through 12/31/2011 Page 29 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE (IF COMMITTEE, ALSO ENTER I D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN- 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Aaron Piombo Fx] IND Police Officer 61,85 557.35 ❑COM C/o: San Rafael Police Association E]OTH 1520 Fifth AvenueCity Q PTY of San Rafael San Rafael, CA 94901 SC qznion member's dues received through intermediary: an qafael Police Association. 1520 Fifth Avenue. San Rafael, CA 9490L 12/20/2011 lan Piombo nx IND Police Officer 61.85 557.35 F -ICOM !71Union C/o: San Rafael Police Association E] OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 member's dues received throuqh intermedia xv:E;aSnCIizafael Police Association. 1520 Fifth Avenue San Rafael, CA 9490L 12/20/2 011 Alan Piombo nx IND Police Officer 61.85 557,35 EICOM C/o: San Rafael Police Association Ej OTH 1520 Fifth AvenueCity El PTY of San Rafael San Rafael, CA 94901 C Union member's dues received through intermedia rv:qanC Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Kenneth Poeh-iman nx IND Police Officer 61.85 557.35 ncom C/o; San Rafael Police Association nOTH City of San Rafael 1520 Fifth Avenue n PTY San Rafael, CA 94901 Union member's dues received through intermedia ny:qa:CCRafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Kenneth Poehlman ®IND Police Officer 61.85 557.35 ncom C/o: San Rafael Police Association ❑ OTH City of San Rafael 1520 Fifth Avenue PTY San Rafael, CA 94901 Union member's dues received through intermedia :Q�P;,afae[l Police Association, 1520 Fifth Avenue, S n Rafael, CA 949011 *Contributor Codes IND—individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.neffile.com SUBTOTAL$ 309,25 FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA_ to whole dollars. / ' from 10/23/2011 through 12/31/2011 Page 30 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE (IF COMMITTEE, ALSO ENTER I D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Dennis PrinceX ❑ IND Police Officer 61.85 557.35 [:]COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 Union member's dues received thr u h int Ra a Police Association 1520 Fifth Avenue.S n R Rafael. A 9496man 12%20/2011 Dennis Prince Mx IND police Officer 61.85 557.35 ❑ COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑ PTY City of Sari Rafael San Rafael, CA 94901 �� Union member's dues received through intermedia :`'fan Rafae Police Association 1520 Fifth Avenue San Rafael CA 9490 12/20/2011 Marius Ramos ❑x IND Police Officer 61.84 123.68 [:]COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue❑Pl.Y Y City of San Rafael San Rafael, CA 94901 �i�11 Union member's dues received through intermedia :`3antafae Police Association 1520 Fifth Avenue San Rafael CA 9490 12,20J2011 Ramos Mari -us❑ IND Police Officer 61.84 123.68 ❑ COM C/o: San Rafael Police Association []OTH City of San Rafael '520 Fifth Avenue ❑ PTY San Rafael, CA 94901 ((�� Union member's dues received through intermedia :`;an Rafae Police Association, 1520 Fifth Avenue, Sin Rafael, CA 9490 12/20/2011 Ronda Reese QIND Police Officer 61.85 3 557.35 ❑ COM ' C/o: San Rafael Police Association [:] OTH City of San Rafael 11520 Fifth Avenue ❑ PTY �an Rafael, CA 94901G{i('� UnlOn nember's dues received through intermedia v' of ae Po�ice Association 1520 Fifty: Avenue Szin Rafael, CA 9490 `Contributor Codes IND—individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.netrile.com SUBTOTAL$ 309.23 E FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE A (CONT.) Statement covers period from 10/23/2011 through 12/31/2011 ( Page 31 of 41 831553 DATE I FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION (IF COMMITTEE. ALSO ENTER I D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN- 1 -DEG_ 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Ronda Reese ❑IND Police Officer 61.85 557.35 DCOM C/o: San Rafael Police Association EIOTH 1520 Fifth Avenue r-1 PTY City of San Rafael San Rafael, CA 94901 QSCC Union member's dues received through inte mediarv: -an Rafael Police Association, 1520 Fifth Avenue. S Rafael, CA 9490� - 12/20/2011 Margo R-hrbacher nx IND Police Officer 61.84 499.17 FICOM C/o: San Rafael Police Association n OTH 1520 Fifth Avenue El PTY City of San Rafael San Rafael, CA 94901 Union member's dues gb intermedia 1v:q.S,CCRafael Police Association, 1520 Fifth Avenue, San Rafael CA 94901 12/20/2011 _received _throe Margo Rohrbacher nx IND Police Officer 61.84 499.17 ncom C/o; San Rafael Police Association FIOTH 1520 Fifth Avenue City of San Rafael San Rafael, CA 94901❑PTY CRafael Union member's dues received through intermedia iv:qaSnC Police Association, 1520 Fifth Avenue, S Rafael, CA 94901 — 12/20/2011 Peggy Ruge BIND Police Officer 61.84 557.33 [:]COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue ❑ PTY City of San Rafael S.. Ra�..! , CA 94901 Union member's dues received through intermedia zy:qaSnK.fael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Peggy Rugs nx IND Police Officer 61.84 557.33 [:]COM Clo: San Rafael Police Association El OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 Un 23VD_§PCRafaeIl : Police Association, 1520 Fifth Avenue, S�n Rafael, CA 9490rL *Contributor Codes IND -individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee www.netfile.com SUBTOTAL$ 309,21 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA460 to whole dollars. from 1OJ23/2011 • RM through 12/31/2011 Page 32 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 ZICODE O FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE (IF COMMITTEE, ALSOAND ENTERP OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. i -DEC. 31) (IF REQUIRED) OF BUSINESS) 12J20J201i Thomas Sabido QX IND Police Officer 61.84 557.33 ❑ COM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue r-1 PTY City of San Rafael San Rafael, CA 94901 Sn Rafae Union member' dues received throu hintermedia Police Association. 1520 Fifth Avenue. San Rafael CA 9490 12/20/2011 Thomas Sabido QIND Police Officer 61.84 557.33 ❑ COM C/o: San Rafael Police Association R OTH 1520 Fifth Avenue R PTY City of San Rafael San Rafael, CA 94901 Union member's dues received throu h intermedia :�an Rafae Police Association 1520 Fifth Avenue San Rafael CA 9490 12J20f2011 George Schikore ❑X IND Police Officer 61.84 557.33 [:]COM C/o: San Rafael Police Association OTH 1520 Fifth AvenueCity Y ❑P,.I.Y of San Rafael San Rafael, CA 94901 (� Union member's dues received through intermedia :`man i2a£ae Police Association 1520 Fifth Avenue San Rafael CA 9490 12/20/2011 George Schikore ❑x IND Police Officer 61.84 557.33 ❑ COM CJo: San Rafael Police Association ❑ OTH City of San Rafael 1520 Fifth Avenue F] PTY San Rafael, CA 94901 {; Union member's dues received through intermedia : qa: T2afae Police Association, 1520 Fifth Avenue, S n Rafael, CA 9490 12/20/2011 Justin Schraeder [9 IND Police Officer 61.84 557.33 ❑ COM C/o: San Rafael Police Association. ❑ OTH City of Sari Rafael 1520 Fifth Avenue PTY San Rafael, CA 94901 (�G{�r I Union member's dues received through intermedia afae Police Association 15201 Fifth Avenue San Rafael CA 9490 *Contributor Codes IND—individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.neffile.com SUBTOTAL$ 309 20 FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM through 12/31/2011 Page 33 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JW 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Just -In Schraeder RIND Police Officer 61.84 557.33 F -ICOM C/o: San Rafael Police Association DOTH 1520 Fifth Avenue ❑PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia xv:E;aS :CCRafael Police Association, 1520 Fifth Avenue. San Rafael. CA 94901 12/20/2011 Wanda Spaletta MIND Police Officer 61.64 557.33 FICOM C/o: San Rafael Police Association F-1 OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 E 1 Union member's ediaxv:;anCCRafae1 Police Association, 1520 Fifth Avenue, S n Rafael, CA 94901 12/20/2011 Wanda Spaletta MIND Police Officer 61.84 557.33 [:]COM . C/o: San Rafael Association police Ej OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia :`-fan Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2 oll David Starnes MIND Police Officer 61.84 557.33 EICOM C/o: San Rafael Police Association F-1 OTH City of San Rafael 1520 Fifth Avenue ❑ PTY San Rafael, CA 94901 Union member's dues received through intermedia ry:qaS:C�.fael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 David Starnes MIND Police Officer 61.84 557.33 ncom IC/c: San Rafael Police Association 1 ❑ OTH City of San Rafael 1520 Fifth Avenue ❑PTY San Rafael, CA 94901 San Q§xYCZafael1 member's dues received through intermediary: Police Association, 1520, Fifth Avenue, San Rafael, CA 9490[L Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.netfile.com SUBTOTAL$ 309.20 FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 460 from 10/23/2011 FORM 1 I through 12/31/2011 Page 34 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION (IF COMMITTEE, ALSO ENTER I D NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN- 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Christopher Sweeney Fx� IND Police Officer 61.84 557.33 FICOM C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue F] PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermediaiv: qSCC an Rafael Police Association, 1520 Fifth Avenue. San Rafael. CA 94901 12/20/2011 Christopher Sweeney nx IND Police Officer 61,84 557.33 ncom C/o: San Rafael Police Association El OTH 1520 Fifth Avenue E] PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through intermedia :`-San Police Association 1520 Fifth Avenue, S n Rafael. CA 94901 12/20/2011 Charly Taylor nx IND Police Officer 61.84 557.33 ncom C/o: San Rafael Police Association Ej OTH 1520 Fifth Avenue ❑ PTY City of San Rafael San Rafael, CA 94901 union member's dues received through intermedia iv:qaS :C`ilafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Charly Taylor nx IND Police Officer 61.84 557.33 EICOM C/o: San Rafael Police Association ❑ OTH City of San Rafael 1520 Fifth Avenue ❑PTY San Rafael, CA 94901 S Union member's dues received through intermedia iy:E;a nC Rafael Police Association, 1520 Fifth Avenue, S Rafael, CA 94901 — 12/20/2011 Chuck Tirre [N IND Police Officer 61.84 557.33 F1 COM C/o: San Rafael Police Association OTH City of San Rafael 1520 Fifth Avenue PTY Sar. Rafael, CA 94901 jUnion member's dues received through intermedia .QP Police Association, 15201 Fifth Avenue, Sdn Rafael, CA 9490[L SUBTOTAL$ 1 1 309.20 *Contributor Codes IND—individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee www.neffile.com FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. III 460 from 10/23/2011 FORM through 12/31/2011 Page 35 of 41 NAME OF FILER I.D. NUMBER San Rafael Police Association Political Action Committee 831553 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR I CONTR BUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN, 1 - DEC 31) (IF REQUIRED) OF BUSINESS) 12/20/2011 Chuck Tirre IND Police Officer 61.84 557.33 FICOM C/o: San Rafael Police Association F-1 OTH 1520 Fifth Avenue El PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through inter ediaiv:qanCCRafael Police Association. 1520 Fifth Avenue. San Rafael. CA 94901 12/20/2011 Michael Vergara rx-1 IND Police Officer 61.84 557.33 n Com C/o: San Rafael Police Association [:] OTH 1520 Fifth Avenue E] PTY City of San Rafael San Rafael, CA 94901 Union member's dues received through interTnedia:I:v:E;aS:CRqfael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12/20/2011 Michael Vergara HIND Police officer 61.84 557.33 F-1 com C/o: San Rafael Police Association ❑ OTH 1520 Fifth Avenue E] PTY City of San Rafael San Rafael, CA 94901 C Union member's dues received through intermedia ::;an i2afael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 nIND [] COM DOTH n PTY El SCC E] IND OCOM n OTH n PTY E] SCC *Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY— Political Party SCC — Small Contributor Committee rk"N"MM+ SUBTOTAL$ 185.52J FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule C Type or print in ink. SCHEDULE C Amounts may be rounded Nonmonetary Contributions Received to dollars. Statement covers period • - whole • from 10/23/2011 • ' through 12/31/2011 Page 36 of 41 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.O. NUMBER San Rafael Police Association Political Action Committee 831553 FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER DESCRIPTION OF AMOUNT! CUMULATIVE TO DATE PER ELECTION DATE CODE OF CONTRIBUTOR CODE * OCCUPATION AND EMPLOYER GOODS OR SERVICES FAIR MARKET CALENDAR YEAR TO DATE RECEIVEDZIP (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) VALUE (JAN 1 - DEC 31) IF REQUIRED) 10/25/2011 San Rafael Police Association BIND Bill Paid By 662.55 3,715.82 RCOM Third Party 1520 Fifth Avenue ®OTH San Rafael, CA 94901 PTY I❑ Committee sponsor payment for accountingsery cels-' aCig to: Henry C. Levy & Company, 5940 College Avenue, Oa land, CA 94618 11/22/2011 San Rafael Police Association RIND Bill Paid By 702.99 3,715.82 ❑COM Third Party 1520 Fifth Avenue ®OTH R PTY San Rafael, CA 94901 Committee sponsor payment for accounting sery ceLli§pt3'to: Henry C. Levy & Company, 5910 College Avenue, Oa land, CA 94618 11/22/2011 San Rafael Police Association EIIND Bill Paid By 888.75 3,715.82 ❑COM Third Party 1520 Fifth Avenue GOTH El PTY San Rafael, CA 94901 Committee sponsor payment for accounting sery ce0Ag9 to: ienry C. Levy & Company, 5940 College Avenue, Oa land, CA 94618 12/21/2011 San Rafael —Police Association [IIND Bill Paid By 333.80 3,715.82 Third Party ❑COM 1520 Fifth Avenue X❑O-IH D PT San Rafael, CA 94901 Committee sponsor payment for accounting sery r + ce©p£q to: Fenry C. Levy & Company, 59 0 College Avenue, Oa land, CA 94618 Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 2,S88.09 1 1 Schedule C Summary 1. Amount received this period — itemized nonmonetary contributions. (Include all Schedule C subtotals.)..................................................................................................................... $ 2. Amount received this period — unitemized nonmonetary contributions of less than $104 .................................... $ 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10) ................. www.netrile.com 2,588.09 0.00 TOTAL $ 2,588,09 *Contributor Codes IND—individual COM — Recipient Committee (other than PTY or SCG) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Foran 464 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER San Rafael Police Association Political Action Committee Type or print in ink. Amounts may be rounded to whole dollars. Ri r� Statement covers period from 10/23/2011 through 12/31/2011 Page 37 of 41 I.D. NUMBER 831553 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW campaign paraphernalia/mise. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG 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 W 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 WEB information technology costs (internet, e-mail) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 0.00 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. ................ $ 0.00 2. Unitemized payments made this period of under $100.......................................................................................................................................... $ 2.00 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).).. ... ___ .......... ......... ............. _ $ 0.00 4. Total payments made this eriod. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. TOTAL $ 2,00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.neffile.com Schedule F Type or print in ink. Statement covers period Amounts may be rounded Accrued Expenses (Unpaid Bills) to whole dollars. from 10/23/2011 through 12/31/2011 SEE INSTRUCTIONS ON REVERSE NAME OF FILER San Rafael Police Association Political Action Committee SCHEDULEF Page 38 of 41 I.D. NUMBER 831553 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/mise. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG 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 M 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 WEB information technology costs (internet, e-mail) * Payments that are contributions or independent expenditures must also be SUBTOTALS $ 5,317.95 $ -669 . 28 $ 0 . o 0 $ 4,648.67 summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.). . ..... ..................... INCURRED TOTALS $ -279.28 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................................. PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) ....., .. NET $ -279.28 May be a negative number FPPC Form 464 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) www.netfile.com ( { (cj {d) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTAA NDING AMOUNTIN CURRED AMOUNT PAID OUTSTANDING (IF COMMITTEE. ALSO ENTER I.D. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ONE) OF THIS PERIOD Henry C. Levy & Company PRO 6.73 -6.73 0.001 0.00 5940 College Avenue 1 I Oakland, CA 94618 Henry C. Levy & Company PRO 662.55 -662.55 0.00 o.00 5940 College Avenue Oakland, CA 94618 Freeman Public Affairs, Inc. IND Mailer including 4,648.67 0.00 0.001 4,648.67 production and postage in support of Andrew 1405 Marcelina Avenue, Suite 111 McCullough for San Torrance, CA 90501. Rafael City Council i 1 * Payments that are contributions or independent expenditures must also be SUBTOTALS $ 5,317.95 $ -669 . 28 $ 0 . o 0 $ 4,648.67 summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.). . ..... ..................... INCURRED TOTALS $ -279.28 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................................. PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) ....., .. NET $ -279.28 May be a negative number FPPC Form 464 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) www.netfile.com Schedule F Type or print in ink. SCHEDULE F (CONT.) Amounts may be rounded Statement covers period CALIFORNIA (Continuation Sheet) to whole dollars. FORM • Accrued Expenses (Unpaid Bills) from 10/23/2011 through 12/31/2011 Page of 39 41 NAME OF FILER LD. NUMBER San Rafael Police Association Political Action Committee 831553 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MiG 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 WEB information technology costs (internet, e-mail) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS $ 22, 243.33 $ 0.00 $ 0.00$ 22,243 .33 FPPC Form 464 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) www.netfile.com l ( (c) (d) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTAA NDING AMOUNT INNCURRED AMOUNT PAID OUTSTANDING (IF COMMITTEE. ALSO ENTER 11) NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD Freeman Public Affairs, Inc. IND Mailer including 4,648.67 0.00 0.00 4,648.67 production and E in support of 1405 Marcelina Avenue, Suite 111 Damon Ccnnoll for Torrance CA 90501 San Rafael Ci y Council Freeman Public Affairs, Inc. IND Mailer including 4,648.66 0.00 0.00 4,648.66 production and pOstac�e in Support of 1405 Marcelina Avenue, Suite lil Gary Phillips for San Torrance CA 90501 Rafael Mayor. Freeman Public Affairs, Inc. IND Mailer including 6,473.00 0.00 0.00 6,473.00 production and 1465 Marcelina Avenue, Suite 111 stage in sugort of Torrance CA 90501 ary )hillips or San Rafael Mayor. Freeman Public Affairs, Inc. IND Mailer including 6,473.0000 0.00 0.00 6,473.00 production and i 1405 Marcelina Avenue, Suite 111. ostage in opposition far Torrance CA 90501 o Greo Brockbank San Rafael Mayor. SUBTOTALS $ 22, 243.33 $ 0.00 $ 0.00$ 22,243 .33 FPPC Form 464 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) www.netfile.com Schedule F Type or print in ink. SCHEDULE F (CONT,) Amounts may be rounded Statement covers period (Continuation Sheet) to whole dollars. Accrued Expenses (Unpaid Bills) from 10/23/2011 through 12/31/2011 Page 40 of 41 NAM E OF FILER I- I D NUMBER San Rafael Police Association Political Action Committee 831553 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW campaign paraphernalia/misc. IVIBIR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL Lv. 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 WEB information technology costs (internet, e-mail) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF CREDITOR (IF COMMITTEE, ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT a) OUTS(TA BALANCE BEGINNING OF THIS PERIOD (b)NDING AMOUNT IN THIS PERIOD (c) AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) (d)CURRED OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD Rutan & Tucker LLP Five Palo Alto Square, 3000 El Camino Real, Suite 200 Palo Alto CA 94306 PRO 0.00 390.00 0.00 390.00 SUBTOTALS $ 0.00 $ 390.00 $ 0.00$ 390.00 FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) www.netfile.com Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVERSE NAME OF FILER San Rafael Police Association Political Action Committee Type or print in ink. Amounts may be rounded Statement covers period to whole dollars. from 10/23/2011 through 12/31/2011 Page 41 of 41 I.D. NUMBER 831553 DATE FULL NAME AND ADDRESS OF SOURCE DESCRIPTION OF RECEIPT AMOUNT OF RECEIVED I (IF COMMITTEE, ALSO ENTER 10. NUMBER) I I INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets, Schedule I Summary 1. Itemized increases to cash this period . ............. ........... ....... ........... ____ .............. __ ....... ...... ................... $ 2. Unitemized increases to cash of under $100 this period . ......................... ...... ... ___ ............. .... ____ ......... $ 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ...... _ ............... $ 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14) ...... ....... ... ... TOTAL $ www.netfile.com SUBTOTAL $ 0.00 0.21 0.00 0.21 0.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)