HomeMy WebLinkAboutForm 410- Lucia Martel Dow for San Rafael School Board 2022; Termination (State-Digital) 05-16-23DocuSign Envelope ID: 511394C71-AD75-4C56-8l3CD-24F0534l3A4AA
Statement of Organization
Date Stamp
CALIFORNIA
'
i
Recipient Committee
•
Statement Type
LJ Initial
❑* Amendment
Q Termination — See Park 5
DIGITALLY
RECEIVED AND FILED
in the office of the California
11 E G
V
IE 0 W E
Q Not yet qualified
or
Secretary of State
U
Q Date qualification threshold met
Date qualification threshold met
Date of termination
March 16 2023
07 / 30�/ 2022
12 31 /_10 2 2
MAY
1 6 2023
1- Committee Information
I.D. Number
=2-
Treasurer and Other Principal Officers(if
applicable) 1442869}
NAME OF COMMITTEE
NAME OF TREASURER
Lucia Martel Dow for San Rafael School Board 2022
Lucia Martel Dow
STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS INO P.O. BOX1 CITY STATE ZIP CODE AREA COOEJPHONE
Novato CA 94949-5731 (
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
Novato CA 94949-5731 (
FULL MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
DOMICILE I JURISDICTION WHERE COMMITTEE IS ACTIVE
Marin County ISan Rafael
Attach additional information on appropriately labeled continuation sheets.
Nancy L Warren
STREET ADDRESS (NO P.O. BOX)
CITY STATE 21P CODE AREA CODE/PHONE
Novato CA 94949-5731 (
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE AREA CODE/PHONE
3. Verification _
I have used all reasonable diligence in preparing
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
W W W.fppc.ca.gov
DocuS4gn Envelope ID: 51B94C71-AD75-4C56-8BCD-24FO534BA4AA
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Lucia Martel Dow for San Rafael School Board 2022
4_ Type of Committee (Continued)
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
GROUP OR AFFILIATION OF SPONSOR
Page 3 of 3
1 D. NUMBER
STREETADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
❑ I I
Date qualified
5. Termination Requirements By sighing theverification, the treasurer, assistant treasurer and/or candidate, of icehDlder, c propDnent certlfythat all of the following conditions have 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 may be 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