HomeMy WebLinkAboutForm 410 - Maika Llorens Gulati for City Council 2020Statement of Organization
Recipient Committee
Statement Type 10 initial
Amendment 10 Termination —See
Not yet qualified
or
Date qualification threshold met I Date qualification threshold met Date of termination
1
F E 9 - 5 2020
CLERK'S
For official use only
I.D. Number
1. Comrrmhtee InformiMon. Z. treasurer and Ot11 #ier Princi�al kers
(if applicable)
NAME OF COMMITTEE NAME OF TREASURER
Maika Llorens Gulati for San Rafael City Council District 1 2020 Maika Llorens Gulati
STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA 94901
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
San Rafael CA 94901
FULL MAILING ADDRESS (IF DIFFERENT)
E MAILADDRESS (REQUIRED) / FAX (OPTIONAL)
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE 15 ACTIVE
Marin City of San Rafael
Attach additional information on appropriately labeled continuation sheets.
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
Maika Llorens Gulati
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA COD E/PHONE
San Rafael CA 94901
3. Ve c on ..
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury unfler the laws of the State of California that the foregoi rue and rrect.
Executed on � C� � By
OAT
1 2
Executed on /7 Z� By
DATE GNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on I By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D. NUMBER
Maika Llorens Gulati for San Rafael City Council District 1 2020
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Redwood Credit Union 1800-479-7928 111000000641127
ADDRESS
CITY
STATE ZIP CODE
209 Third Street San Rafael CA 94901
4. TNpe pf Cctnmil!iPd Ciomplel�e the a�`plfcable.seWtins. 4
• List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and
district number, if any, and the year of the election.
• List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." Stating "No party preference" is acceptable.
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IFAPPLICABLE) ELECTION
CHECK ONE
• Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURES) JURISDICTION
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Nonpartisan
Partisan
(list political party below)
Maika Llorens Gulati
San Rafael City Council District 1
2020
Nonpartisan
Partisan
(list political party below)
• Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURES) JURISDICTION
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Maika Llorens Gulati for San Rafael City Council District 1 2020
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
NAME OF SPONSOR
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
Page 3
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA COD E/PHONE
❑ —/ 1
Date quallfled
5th _erit lhation 111"uirem6nts ayslgningt"e, edjlaation,thutreasumr, assistant treasvrerand/orcandidate, ofllceho}dei•, orpmponentcertify'Aatall ofthefolloWngcon.ditionshave been..met
• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
• This committee has no surplus funds; and
• This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
-- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government
Code Section 89519.
— Leftover funds of ballot measure committees maybe used for political, legislative or governmental purposes under Government Code Sections 89511- 89518, and are
subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov