HomeMy WebLinkAboutForm 410 - Rachel Kertz for City Council 2024C FrM C I K\T/1 : IR
Statement of Organization
Recipient Committee
ID
WOffiffidal
17)
Statement Type ® initial: ❑ Amendment
❑ Termination —See P
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2 9 2024]11
ly
Q Not yet qualified
or
0 Date qualification threshold met Date qualification threshold met
Date of termination
ITY CLERK'S
06 20 2024
Committee1.
2. Treasurer and Other Principal
I c 1lrnbJe
NAME OF COP MIT -TEE
NAME OF TREASURER
Committee to Re-elect Rachel Kertz for San Rafael City Council 2024
Tamara Hull
STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS IND P.O. BOX)
CITY
STATE
ZIPCODE AREA CODE/PHONE
Novato
CA
94945
CITY
STATE ZIP CODE AREACODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
Novato
CA 94945
n/a
FULL MAILING ADDRESS (IF DIFFERENT)
I
STREET ADDRESS (NO P.O, BOX)
same
1
E-MAIL ADDRESS IREQUJRED)/FAX(OPTIONAL)
I
CITY
STATE
ZIPCODE AREA CODE/PHONE
COU NTY OF DOMICILE
]URISDICTION WHERE COMMITTEE IS ACTIVE
NAME OF PRINCIPAL OFFICER(S)
Marin
City of San Rafael
Rachel Kertz
STREET ADDRESS (NO P.O. BOX)
Attach additional information on appropriately Labeled continuation sheets.
CITY
STATE
ZIPCODE AREACODE/PHONE
3. Verification
Novato
CA
94945
I nave urea all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjuryunder�the laws of the State
OFFICEHOLDER, CAN DI DATE, OR STATE MEASURE PROPONENT
Executed on By
DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice fppc.ca.rov (866/275-37721
www.fpbc.ca.eov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
Committee to Re-elect Rachel Kertz for San Rafael City Council 2024 I.D. NUM BER
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION T415-472-2265
REACODE/PHONE BANK ACCOUNT NUMBER
Bank of Marin
ADDRESS CITY STATE ZIP CODE
496 Las Gailinas Avenue #4 San Rafael CA 94903
• 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 iINCt UnF TIKTRICT NIIMRFR IC ADD[ Ir eu1 0 .. r —..
LMtLKUNt
Rachel Kertz
City Council, City of San Rafael, District 4
2024
Nonpartisan
Partisan
(fist political party below)
f
Nonpartisan
Partisan
(list political party below)
PrimarilyFormed Committee, Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) 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 OFFICEHni nFR'S NAMF I..." I.n
SUPPORT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410(August/2018)
FPPC Advice: advicePfooc.ca.gov (866/275-3772)
MNAW.fppc.ca.goy
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
:OMMITTEE NAME Page 3
Committee to Re-elect Rachel Kertz for San Rafael City Council 2024 I.D. NUMBER
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROMS BRIEF DESCRIPTION OFACTMW
Sponsored Committee List additional sponsors on an attachment.
0TV
GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE AREA
Small Contributor Committee
S. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or eanent certify that 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: advi ceW13I3c.ca.1zov (866/275-3772)
wwwJppc.ca.gav