HomeMy WebLinkAboutForm 410 - San Rafael Public Library Foundation (501(c)(3))Statement of Organization Date Stamp 14F.,
Recipient Committee ''
Statement Type ® Initial ❑ Amendment ❑ Termination — See Part 5 Official Ws Only
0 Not yet qualified
OF
QD Date qualification threshold met Date qualification threshold met Date of termination
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I.D. Number w e m ..
NAME OF COMMITTEE
NAME OF TREASURER
San Rafael Public Library Foundation (501(c)(3))
Charles H Stuckey
STREET ADDRESS (NO P.O. BOX) CITY
STATE ZIP CODE
San Rafael
CA 94901
EMAIL ADDRESS OF TREASURER(REQUIRED)
AREA CODE/PHONE
STREET ADDRESS (NO P.O. BOX)
NAME OF ASSISTANT TREASURER, IF ANY
CITY STATE ZIP CODE AREACODE/PHONE
San Rafael CA 94901
FULL MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS OF COMMITTEE (REQUIRED)/ FAX (OPTIONAL)
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE 15 ACTIVE
Marin I San Rafael
Attach additional information on appropriately labeled continuation sheets.
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE
EMAIL ADDRESS OF ASSISTANT TREASURER(REQUIRED) AREA CODE/PHONE
Gary Ragghianti
STREET ADDRESS (NO P.O. BOX) CITY
STATE ZIP CODE
San Rafael
CA 94901
EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED)
AREA CODE/PHONE
I have used all reasonable diligence in preparing
MEASURE PROPONENT
Executed on
By
GATE
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(October/2023)
FPPC Advice: adviceo�fgEJ_r.,ca,gov_(866/275.3772)
www.fPPc�Ca;gov
Statement of organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
San Rafael Public Library Foundation (501(c)(3))
Page 2
I.D. NUMBER
All committees must list the financial institution where the campaign bank account is located and the person(s) authorized to obtain bank records.
NAME OF FINANCIAL INSTITUTION AND PERSON(S) AUTHORIZED TO OBTAIN BANK RECORDS AREA CODE/PHONE BANK ACCOUNT NUMBER
Bank of Marin 415-485-2265
Charles Stuckey
ADDRESS OF FINANCIAL INSTITUTION CITY STATE ZIP CODE
1101 Fourth Street San Rafael CA 94901
• 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." 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 (IN CLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION rHFCKnNF
Nonpartisan
Partisan
(list political party below)
Nonpartisan
Partisan
(list political party below)
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) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DIST RICT NO., CITY OR COUNTY, AS APPLICABLEI 1HFrK—,`
San Rafael Public Libraries & Community Center Initiative
Marin County, San Rafael, CA
SUPPORT
011119E
SUPPORT
01P056
FPPC Form 410 (October/2023)
FPPC Advice: advice_(a7fppc,cagav_(866/275-3772)
wW W—fVC.Ca.,� 0v
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.o. NL
San Rafael Public Library Foundation (501(c)(3))
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 INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREETADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
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• 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 (October/2023)
FPPC Advice: advice@fpRc.ca,gov_(866/275-3772)
www.Aipc_ca..Fav