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Home My WebLink AboutForm 460 - Carolina Martin for San Rafael School Board Trustee 2022; (2023-06-30)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Statement covers period from 01/01/2023 through 06/30/2023 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part5) 0 Sponsored (Also Complete Part 6) ❑ General Purpose Committee 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part7) 3. Committee Information I I.D. NUMBER 1449397 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Carolina Martin for San Rafael City Schools District 4 2022 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Lakeport CA 95453 ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE Date of election if appli a�IP" ❑ i I 1 i 1 5 (Month, Day, Year) s� I s ge of For Official Use Only 11/08/2022 PITY i ''S OFFICE 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement ® Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Chelsea Johnson MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE Lakeport CA 95453 ( NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE 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 best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true on Date Executed on Date By Signature of Controlling Officeholder, Candidate, State Measure Proponent By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) www.fppc.ca.gov COVERPAGE-PART2 Recipient Committee CALIFORNIA I Campaign Statement ' Cover Page — Part 2 Page z of 5 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Carolina Martin OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT Board of Education City of San Rafael District 4 ❑ OPPOSE RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Identify the controlling officeholder, candidate, or state measure proponent, if any. San Rafael CA 94901 NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT 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 OFFICE SOUGHT OR HELD contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidates) for which this committee is primarily formed. ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) DISTRICT NO. IF ANY 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 CITY STATE ZIP CODE AREA CODE/PHONE 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 Amounts may be rounded Statement covers period - Summary Page to Whole dollars. / , from 01/01/2023 � SEE INSTRUCTIONS ON REVERSE through 06/30/2023 Page 3 of 5 NAME OF FILER I.D. NUMBER Carolina Martin for San Rafael City Schools District 4 2022 1449397 AoD Column B Calendar Year Summary for Candidates Contributions Received ToCoolumn Running in Both the State Primary and (FROM ATTACHED SCHEDULES) TOTALTO DATE General Elections 1. Monetary Contributions ........................................... Schedule A, Line $ 0.00 $ 0.00 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 $ 0.00 $ 0.00 20. Contributions Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 0.00 0.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED•.••..••.............••••••AddLines3+4 $ 0.00 $ 0.00 Made $ $ Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 $ 736.24 $ 736.24 7. Loans Made............................................................. Schedule H, Line 3 0.00 0.00 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ 736.24 $ 736.24 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 0.00 0.00 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 0.00 0.00 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8+9+10 $ 736.24 $ 736.24 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 13. Cash Receipts ................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 15. Cash Payments .................................................. Column A, Line 8 above 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 5,282.44 To calculate Column B, add 0.00 amounts in Column A to the corresponding amounts from Column B of your last 330.82 736.24 report. Some amounts in Column A may be negative 4,877.02 figures that should be subtracted from previous period amounts. If this is the first report being filed 0.00 for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). 0.00 0.00 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) *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) www.fppc.ca.qov SCHEDULE E Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. Carolina Martin for San Rafael City Schools District 4 2022 Statement covers period from 01/01/2023 through 06/30/2023 page 4 of 5 I.D. NUMBER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 1449397 CMP campaign paraphernalia/misc. MBR member communications RAID 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) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID CJ & Associates, Inc. PRO 441.24 Lakeport, CA 95453 CJ & Associates, Inc. I PRO 1 1 125.00 Lakeport, CA 95453 CJ & Associates, Inc. I PRO 1 1 120.00 Lakeport, CA 95453 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 686.24 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. $ 686.24 2. Unitemized payments made this period of under $100.......................................................................................................................................... $ 50.00 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 Summary Page, Column A, Line 6. TOTAL $ 736.24 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov Schedule I SCHEDULE[ Miscellaneous Increases to Cash Amounts may be rounded Statement covers period . to whole dollars. from 01/01/2023 through 06/30/2023 11D e 5 of 5 SEE INSTRUCTIONS ON REVERSENAME OF FILER NUMBER Carolina Martin for San Rafael City Schools District 4 2022 1449397 DATE FULL NAME AND ADDRESS OF SOURCE AMOUNT OF RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT INCREASE TO CASH 06/30/2023 Bank of America Refund 330.82 San Rafael, CA 94901 Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 330.82 Schedule I Summary 1. Itemized increases to cash this period........................................................................................................................ $ 330.82 2. Unitemized increases to cash of under $100 this period............................................................................................. $ 0.00 3. Total of all interest received this period on loans made to others. Schedule H, Column e . 0.00 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the SummaryPage, Line 14.) ......................................................................................................................... .. TOTAL $ 330.82 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) www.fppc.ca.gov