HomeMy WebLinkAboutForm 465 - Police Association PAC (2011-10-22) Supporting Gary PhillipsSupplemental Independent
Expenditure Report
(Government Code Section 84203.5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Amounts may be rounded to
whole dollars.
❑ Amendment (Explain Below)
I.D. NUMBER (if recipient committee)
1. Committee/Filer Information 831553
COMMITTEE/FILER'S NAME
San Rafael Police Association Political Action Committee
STREET ADDRESS (NO P.O. BOX)
1520 Fifth Avenue
CITY STATE ZIP CODE AREA CODEIPHONE
San Rafael CA, 94901 (415) 485-3000
OPTIONAL: FAX/E-MAIL ADDRESS
Report covers period
from 09/25/2011
through 10/22/2011
Date of election if applicable:
(Month, Day, Year)
11/08/2011
Treasurer (if recipient committee)
NAME OF TREASURER
Mr. Scott Ingels
MAILING ADDRESS
1520 Fifth Avenue
SUPPLEMENTAL
Date Stamp 0
EXPENDITURE
Page 1 of 3
For Official Use Only
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA, 94901 (415) 485-3000
OPTIONAL: FAX/E-MAIL ADDRESS
2. Name of Candidate or Measure Supported or Opposed CHECKONE
NAME OF CANDIDATE
Gary Phillips
OFFICE SOUGHT OR HELD AND DISTRICT, IF APPLICABLE
Mayor City of San Rafael, CA
SUPPORT
X
OPPOSE
NAME OF BALLOT MEASURE
BALLOT NO./LETTER
JURISDICTION
SUPPORT
OPPOSE
3. Independent Expenditures Made Attach additional information on appropriately labeled continuation sheets.
CUMULATIVE TO DATE
DATE
NAME AND ADDRESS OF PAYEE
DESCRIPTION OF EXPENDITURE
AMOUNT
(JAN.
Freeman Public Affairs, Inc.
4,648.66
Mailer including production and postage
10/17/2011
1405 Marcelina Avenue, Suite 111
in support of Gary Phillips for San
20,115.73
Rafael Mayor.
Torrance, CA 90501
U.S. Postmaster
2,100.00
Postage for mailer in support of Gary
MEMO
10/17/2011
1433 Marcelina Avenue
Phillips for San Rafael Mayor
Subpayment made
through:
Freeman Public
ffairs,
Torrance, CA 90501
Inc.
Freeman Public Affairs, Inc.
6,473,00
Mailer including production and postage
10/19/2011
1405 Marcelina Avenue, Suite Ill
in support of Gary Phillips for San
20,115.73
Rafael Mayor.
Torrance, CA 90501
FPPC Form 465
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)
Supplemental Independent Type or print in ink.
Expenditure Report Amounts may be rounded
p P to whole dollars.
SEE INSTRUCTIONS ON REVERSE
For use by an officeholder, candidate, or committee making independent expenditures totaling $500 or
more in a calendar year to support or oppose a single candidate or a single measure. This form must
be filed at the same times and places as the campaign statements filed by the candidate supported or
opposed or by a committee primarily formed to support or oppose the measure. A separate form must
be filed for each candidate or measure being supported or opposed. This form is filed in addition to
anv other required campaign statements.
Report covers period
from 09/25/2011
through— 10/22/2011
Date of election if applicable:
(Month, Day, Year)
11/08/2011
Page 2 of 3
For Official Use Only
iv i naepenaeni
DATE
txpenanures mase Attacn aaditionat intonnatron on appropnateiy iaoetea continuation sneets. CALENDAR YEAR
NAME AND ADDRESS OF PAYEE DESCRIPTION OF EXPENDITURE AMOUNT (JAN. 1 - DEC. 31)
10/19/2011
U.S. Postmaster
1433 Marcelina Avenue
Torrance, CA 90501
Postage for mailer in support of Gary
Phillips for San Rafael Mayor
3,150.00
MEMO
Subpayment made
Freeman Public
Inc.
through:
%ffairs,
Supplemental Independent Type or print in ink. SUPPLEMENTAL INDEPENDENT EXPENDITURE
Amounts may be rounded Report covers period
Expenditure Report to whole dollars. from 09/25/2011
10/22/2011
SEE INSTRUCTIONS ON REVERSE through Page 3 of 3
NAME OF FILER I.D. NUMBER (if recipient corn.)
San Rafael Police Association Political Action Committee 831553
4. Summary 11,121.66
1. Total independent expenditures of $100 or more made this period. (Part 3.) ........................................................................................... $
2. Total independent expenditures under $100 made this period. Not itemized......................................................................................... $ 0.00
3. Total independent expenditures made this period (Add Lines 1 + 2.) ..........................................................................................TOTAL $ 11,121.66
5. Filing Officers Enter the name and address of each filing officer with whom the filer's most recent campaign statements (Form 450, 460 or 461) have been filed.
1) NAME OF FILING OFFICER 3) NAME OF FILING OFFICER
San Rafael City Clerk
ADDRESS (NO. AND STREET) ADDRESS (NO. AND STREET)
1400 5th Avenue
CITY STATE ZIP CODE CITY STATE ZIP CODE
San Rafael, CA 94901
2) NAME OF FILING OFFICER 4) NAME OF FILING OFFICER
ADDRESS (NO, AND STREET) ADDRESS (NO. AND STREET)
CITY STATE ZIP CODE CITY STATE ZIP CODE
6. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury under the laws of the State of California that the foregoing is true and correct,!",
Executed on By
DATE SIGNATW OF FILER, TREASURER OR ASSISTANT TREASURER
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT, OR RESPONSIBLE OFFICER OF SPONSOR
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
FPPC Form 465
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)