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Home My WebLink AboutForm 460- Lucia Martel Dow for San Rafael School Board; TerminationRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Statement covers period from IC 1:251.102--L through 1*"'1311202;L 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. ❑x Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall Q Controlled fAlso Complete Part 5) O Sponsored (Also Complete Part 6) ❑ General Purpose Committee Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1442859 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Lucia Martel Dow for San Rafael School Board 2022 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Novato CA 94949-5731 ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX Date Stamp Date of election if appli (Month, Day, Year) 11/08/2022 2. Type of Statement: ❑ Preelection Statement -ii-annual Statement Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Lucia Martel Dow COVER PAGE 1 of - Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement - Attach Form 495 MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE Novato CA 94949-5731 ( NAME OF ASSISTANT TREASURER, IF ANY Nancy L Warren MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY Novato STATE ZIP CODE AREA CODE/PHONE CA 94949-5731 ( OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the Porror Executed on By Dale Signature of Controlling Officeholder, Candidate, Stale Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) Recipient Committee Campaign Statement Cover Page — Part 2 S. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Lucia Martel Dow OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) School Board City of San Rafael RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE Z17- Novato CA 94949-5731 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) CITY STATE ZIP CODE AREA CODE/PHONE www.netfile.com 18161MIZ11 WOW =a WFWA:iIV, Page 2 of 7 6. Primarilv Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTE=R JURISD[CTION ❑ 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 officeholder(s) or candidate(s) 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 Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Lucia Martel Dow for San Rafael School Board 2022 Amounts may be rounded to whole dollars. Statement covers period from 10/23/2022 through 12/31/2022 SUMMARYPAGE Page 3 of 7 LD NUMBER 1442869 Expenditures Made Column A Schedule E, Line 4 $ Column B Calendar Year Summary for Candidates Contributions Received Schedule H, Line 3 0.00 TOTALTHISPERIOD 8. SUBTOTALCASH PAYMENTS ..............._................... CALENDARYEAR Primary Running in Both the State Prima and 9. Accrued Expenses (Unpaid Bills)...............................Schedule F, Line -5,109.62 (FROM ATTACHED SCHEDULES) 10. Nonmonetary Adjustment ........................ :.....::.......... TOTALTO DATE g 11. TOTAL EXPENDITURES MADE ............... .::.:.,..:........ AddLines8+9+10 $ 466.27 General Elections 1. Monetary Contributions .......................................... Schedule A, Line 3 $ 500.00 $ 9,524.00 1/1 through 6/30 7/1 to Date 2. Loans Received ............................................... .....:. Schedule B, Line 3 0.00 0.00 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 500.00 $ 9,524.00 20. Contributions Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 0.00 0.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3+4 $ 500.00 $ 9,524.00 Made $ $ Expenditures Made 6. Payments Made .......................... ... Schedule E, Line 4 $ 5,575.89 7. Loans Made.............................................................. Schedule H, Line 3 0.00 8. SUBTOTALCASH PAYMENTS ..............._................... Add Lines 6+7 $ 5,575.89 9. Accrued Expenses (Unpaid Bills)...............................Schedule F, Line -5,109.62 10. Nonmonetary Adjustment ........................ :.....::.......... Schedule C, Line 3 0.00 11. TOTAL EXPENDITURES MADE ............... .::.:.,..:........ AddLines8+9+10 $ 466.27 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 5,075.89 13. Cash Receipts ........................ ......... Column A, Line 3 above 500.00 14. Miscellaneous Increases to Cash ........................... Schedule /, Line 4 0.00 15. Cash Payments .................................................. Column A, Line 8 above 5,575.89 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 0.00 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ 0.00 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ......................................... See instructions on reverse $ 19. Outstanding Debts .......................... Add Line 2 + Line 9 in Column B above $ www.netfile.com 0.00 0.00 $ 9,524.04 0.00 $ 9,524.00 0.00 0.00 $ 9,524.00 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). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) r i � *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Monetary Contributions Received SCHEDULE A Amounts may be rounded Statement covers period SUBTOTAL$ 500.00 Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.)........................................................................................................ $ 2. Amount received this period — unitemized 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.) ....................... TOTAL $ www.netfile.com 500.00 0.00 500.00 *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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) www.fppc.ca.gov from 10/23/2022 �- through .12/31/2022 Page 4 of 7 SEE INSTRUCTIONS ON REVERSE I.D. NUMBER NAME OF FILER Lucia Martel Dow for San Rafael School Board 2022 1442869 DATE DEO FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR A RE,ALSAND ZIP CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, O ENTER I,D.N IT CODE* (IFSELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC 31) (IF REQUIRED) OF BUSINESS) 10/31/2022 San Rafael Federation of Teachers PAC (ID# ❑IND 500.00 500.00 G2022 $500.00 1436380) ❑X COM ❑ OTH San Rafael, CA 94901-4126 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC []IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 500.00 Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.)........................................................................................................ $ 2. Amount received this period — unitemized 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.) ....................... TOTAL $ www.netfile.com 500.00 0.00 500.00 *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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Lucia Martel Dow for San Rafael School Board 2022 Amounts may be rounded to whole dollars. Statement covers period from 10/23/2022 through 12/31/2022 Page 5 of 7 I.D. NUMBER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment 1442869 CMP campaign paraphernalia/misc. 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 FIND 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) NAME AND ADDRESS OF PAYEE (I F COMMITTEE, ALSO ENTER I.D. NUMBER) Citicard New York, NY 10013 Citicard New York, NY 10013 Miguel Carlo G. David Carson, CA 90745 CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID LIT / POS 3,416.76 LIT POS 160.01 540.00 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 4,116.77 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. ........................... $ 5,575.89 2. Unitemized payments made this period of under $100.......................................................................................................................................... $ 0.00 3. Total interest paid this period on loans. Enter amount from Schedule B, Part 1, Column (e).) ............. $ 0.00 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summa Page, Column A, Line 6. 5.575.89 P Y P ( Summary 9 ) ......................:.:.... TOTAL FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov www.neffile.com Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. Statement covers period from 10/23/2022 through 12/31/2022 SCHEDULE E Page 6 of? I.D. NUMBER Lucia Martel Dow for San Rafael School Board 2022 1442869 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants NTfG 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. SUBTOTAL $ 1,459.12 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.neffile.com www.fppc.ca.gov SCHEDULEF Schedule F Amounts may be rounded Statement covers period • ' . ■ Accrued Expenses (Unpaid Bills) to whole dollars. from 10/23/2022 through 12/31/2022 SEE INSTRUCTIONS ON REVERSE NAME OF FILER Lucia Martel Dow for San Rafael School Board 2022 Page 7 of 7 I.D. NUMBER 1442869 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalia/misc. 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 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 $ 5,109.62$ 0.00$ 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.) ...................... 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 $100.) 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.)................................................................ www.netfile.com 5,109.62$ 0.00 ..................... INCURRED TOTALS $ 0.00 ........................ I ..... ..... PAID TOTALS $ 5,109.62 ............ .......... I .................. ....... NET $ -5.109.62 May be a negWirve nuiver FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov (a) (b) (c) (d) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING AMOUNTINCURRED AMOUNTPAID 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 ON E) OF THIS PERIOD Citicard LIT / POS 3,576.77 0.00 3,576.77 0.00 New York, NY 10013 Miguel Carlo G. David WEB 540.00 0.00 540.00 0.00 Carson, CA 90745 wepac LLC PRO/OFC 992.85 0.00 992.85 0.00 Novato, CA 94949 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS $ 5,109.62$ 0.00$ 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.) ...................... 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 $100.) 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.)................................................................ www.netfile.com 5,109.62$ 0.00 ..................... INCURRED TOTALS $ 0.00 ........................ I ..... ..... PAID TOTALS $ 5,109.62 ............ .......... I .................. ....... NET $ -5.109.62 May be a negWirve nuiver FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov