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Home My WebLink AboutForm 460 - Carolina Martin for San Rafael School Board Trustee 2022; (2024-06-30)Recipient Committee COVER PAGE Campaign Statement ' Cover Page (Government Code Sections 84200-84216.5) AUG - 1 2024 Statement covers period Date of election if applicabl 5 (Month, Day, Year) of from 01/01/2024 CITY CLERK'S r Official Use Only OFIF1 Use SEE INSTRUCTIONS ON REVERSE through 06/30/2024 11/08/2022 1. Type of Recipient Committee: All Committees- complete Parts 1, 2, 3, and 4. 2. Type of Statement: ® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement Q State Candidate Election Committee Committee ® Semi-annual Statement ❑ Special Odd -Year Report Q Recall Q Controlled ❑ Termination Statement ❑ Supplemental Preelection (Also Complete Part 5) O Sponsored (Also file a Form 410 Termination) Statement -Attach Form 495 ❑ General Purpose Committee (Also Complete Part 6) ❑ Amendment (Explain below) 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 Treasurer(s) 1449397 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Carolina Martin for San Rafael City Schools District 4 2022 Chelsea Johnson MAILING ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Lakeport CA 95453 ( CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Lakeport CA 95453 ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODEIPHONE 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 and correct. 07/25/2024 Uidrea ,7ohilsofl Executed on By Date i',:1�'alwc cl trea,arc•r or Ass slant i rco5ure� E 07/25/2029 Executed on By I. Date Signature of Controlling Officeholder, Candidate. State Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder, Candidate, State 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 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Carolina Martin OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Board of Education City of San Rafael District 4 RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael CA 94901 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 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 COVER PAGE - PART 2 Page 2 of 5 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ 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 (Jan12016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) Campaign Disclosure Statement Amounts may be rounded Summary Page to Whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Carolina Martin for San Rafael City Schools District 4 2022 Contributions Received 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 2. Loans Received...................................................... Schedule a, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED•.........•................AddLines3+4 $ Expenditures Made To calculate Column B, add 6. Payments Made ................................................... Schedule E, Line 4 $ 7. Loans Made........................................................... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 $ Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 13. Cash Receipts ................................................... Column A, Line 3above 14. Miscellaneous Increases to Cash ........................... Schedule I, 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 $ Column A TOTALTHIS PERIOD (FROM ATTACHED SCHEDULES) 0.00 $ 0.00 0.00 $ 0.00 0.00 $ 1,953.50 $ 0.00 1,953.50 $ 0.00 0.00 1,953.50 $ Statement covers period from 01/01/2029 through Column B CALENDARYEAR TOTALTO DATE 0.00 0.00 0.00 0.00 0.00 1,953.50 0.00 1,953.50 0.00 0.00 1,953.50 9,505.67 To calculate Column B, add 0.00 amounts in Column A to the corresponding amounts from Column B of your last 0.00 1, 953.50 report. Some amounts in Column A may be negative 7, 552.17 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 SUMMARY PAGE 06/30/2024 Page 3 of 5 I.D. NUMBER 1449397 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 711 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ 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/2076) FPPC Advice: advice@fppc.ca.gov (8661275-3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. Statement covers period from 01/01/2024 through 06/30/2024 SCHEDULE E Page 4 of 5 I.D. NUMBER Carolina Martin for San Rafael City Schools District 4 2022 I 1449397 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 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 UT 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) CJ & Associates, Inc. Lakeport, CA 95453 CJ & Associates, Inc. Lakeport, CA 95453 CJ & Associates, Inc. Lakeport, CA 95453 CODE OR DESCRIPTION OF PAYMENT PRO * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.)................................................................... 2. Unitemized payments made this period of under $100............................................................................................... 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).).................................... 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) 1 AMOUNTPAID 60.00 163.00 60.00 SUBTOTAL$ 283.00 ....................................... $ ....................................... $ .......................... TOTAL $ 1,903.50 50.00 0.00 1,953.50 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) Schedule E (Continuation Sheet) Amounts may be rounded Statement covers period to whole dollars. Payments Made from 01/01/2029 SEE INSTRUCTIONS ON REVERSE through 06/30/2024 NAME OF FILER Carolina Martin for San Rafael City Schools District 4 2022 SCHEDULE E Page 5 of 5 I.D. NUMBER 1449397 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 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 (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CJ & Associates, Inc. Lakeport, CA 95453 Glenwood School Foundation San Rafael, CA 94901 CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID PRO 120.50 CVC 1,500.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 1, 620.50 FPPC Form 460 (Jan/2016)