HomeMy WebLinkAboutForm 410- Lucia Martel Dow for San Rafael School Board 2022; Amendment StateStatement of Organization
Recipient Committee
Statement Type ❑ initiai
Amendment i❑ Termination —See
Not yet qualified
or
Date qualification threshold met I Date qualification threshold met
1 30 / 2022
1. Committee Information I.D. Number 1442869
(if applicable)
NAME OF COMMITTEE
Lucia Martel Dow for San Rafael School Board 2022
Date of termination
Date Stamp
tifLl IL; LjillCt• Gi ;:1•.. �.•':L�''.U�y `li .itL'c%ti�
of the State of Californla
AUS 19 2022
SEP 1 2 2022
2. Treasurer and Other Principal Officers I ,, ,ft, rni.►
NAME OF TREASURER
Lucia Martel Dow
STREET ADDRESS (NO P.O. SOX)
STREET ADDRESS IND P.O. BOX) CITY
CITY STATE ZIP CODE AREA CODE/PHONE
Novato CA 94949-5731 (
FULL MAILING ADDRESS OF DIFFERENT)
E-MAIL ADDRESS (AEOUMED} j FAX (OPTIONAL)
JURISDICTION WHERE COMMITTEE I$ AC
San Rafael
Attach additional information on appropriately labeled continuation sheets.
STATE ZIP CODE AREA CODE/PHONE
Novato CA 94949-5731 (
NAME OF ASSISTANTTREASURER, IF ANY
Nancy L Warren
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIPCODE AREACODE/PHONE
Novato CA 94949-5731 (
NAME OF PRINCIPALOFFICERiS)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREACODE/PHONE
3. Verification
I have used all reasonable diligence in preparing
Executed on
DATE
By
SIGNATUREOFCONTRMING 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
2 of 3
COMMITTEE NAME I.D. NUMBER
Lucia Martel Dow for San Rafael School Board 2022 1 1442869
• All committees must list the financial Institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
Bank of San Francisco
ADDRESS
AREA CODE/PHONE
(415)744-6700
CITY
SAW ACCOUNT 17 UM BER
STATE ZIP CODE
575 Market Street 4900 San Francisco CA 94105
4. Type of Committee Complete the applicable sections.
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.
o 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 IF APPLICABLE) ELECTION CHECKONE
Lucia Martel Dow
School Board City of San Rafael
2022
Nonpartisan 1
X
Partisan
(list political party below)
Nonpartisan
Partisan
(lis, poiitiCal party below)
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER)
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO,, CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
T I OPPOSE
OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov