HomeMy WebLinkAboutForm 410 - Maribeth Bushey-Lang for City Council 2013Statement of Organization
Recipient Committee
Statement Type El initial Amendment
Not yet qualified or List I.D. number:
#1358370
06 15 2013
Date qualified as committee Date qualified as committee
(if applicable)
Ak A w Am
Ak
JURISDICTION WHERE COMMITTEE IS ACTIVE
City of San Rafael
Executed on
ermination — See Part s
List I.D. number:
I IM11
Date of Termination
(
For Official Use Only
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NAME OF TREASURER
Mark Kyle
STREET ADDRESS (NO RO. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA 94901 (
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
mm
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
I=
STATE ZIP CODE AREA CODE/PHONE
STATE ZIP CODE AREA CE/PHONE
and to the best of nowled ge the information contained herein is true and complete. I certify under
th foregoin is tr correct.
�7- 2 *
SIGNATUR OF TREASURER OR ASSISTANT TREASURER
SIGNATURE OF CONTROLLING OFFICEAZkbER, CANDIDATE, OR STAVMEASLJRE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Dec/2012)
www.fppc.ca.gov
M
Statement of Organ izabon
Rec*lp*lent Committee
INSTRUCTIONS ON REVERSE Page 2
COMMITTEE NAME I.D. NUMBER
Maribeth Bushey -Lang for San Rafael City Council 2013 1358370
* All committees must list the financial institution where the campaign bank account is located.
• List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and
district number, if any, and the year of the election.
* List the political party with which each officeholder or candidate is affiliated or check "nonpartisan."
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CAN DIDT E/OFFICEH}LC ER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION
Maribeth Bushey San Rafael City Council 1201,5
Primarily Formed Committee 1 Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
Nonpartisan
CHECK ONE
FPPC Form 410 (Dec/2012-)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov