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Home My WebLink AboutForm 410 - Maika Llorens Gulati for City Council 2020; Termination (2024-06-30)Statement of Organization Lam, �tcmgJ U �CALIFORNIA LJ Recipient Committee 410 FORM Statement Type ❑ Initial ❑ Amendment 0 Termination — See Part - A U G 2 For Official Use Only 2024 Q Not yet qualified or O Date qualification threshold met Date qualification threshold met Date of termination CITY CLERK'S OFFIC 06 30 2024 / 1. Committee Information I.D. Number 2. Treasurer and Other Principal Officers (if applicable) 1425910 NAME OF COMMITTEE NAME OF TREASURER Maika Llorens Gulati for San Rafael City Council District 1 2020 Maika Llorens Gulati STREET ADDRESS (NO P O BOX) STREET ADDRESS (NO P.O BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY San Rafael CA 94901 FULL MAILING ADDRESS (IF DIFFERENT) STREET ADDRESS (NO P.0 BOX) ZIP CODE AREA CODE/PHONE E-MAILADDRESS (REQUIRED)/ FAX (OPTIONAL) CITY STATE COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S) Marin City of San Rafael Maika Llorens Gulati STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. San Rafael CA 94901 3. Verification I have used 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 perjury under the laws of the State of California that the foregoing is true and correct. 111LAr"9°° by—k' 06/30/2024 Maika Llorens L1.1-1 GOW Executed on By (,l11?t D-, 2D24 08 pE 1p 3036 DATE Or- BRFaA�iJ�RF-R`PAk.SSISTANT TREASURER Maik�I �C`��J�S 06/30/2024 Executed on By Gulati L,��,a„ Daic:2024.08021021:27 aroo DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE Executed on DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization CALIFORNIA' Recipient Committee F0914 i INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I D NUMBER Maika Llorens Gulati for San Rafael City Council District 1 2020 1425910 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA COD E/PHONE BANK ACCOUNT NUMBER Redwood Credit Union 800-479-7928 ADDRESS CITY STATE ZIP CODE 209 Third Street San Rafael CA 94901 4. Type of Committee Complete the applicable sections. Controlled Committee • 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 (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE 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) IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(5) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) rHFCK nKIF SUPPORT Nonpartisan Partisan (list political party below) Maika Llorens Gulati San Rafael City Council District 1 2020 ❑✓ Nonpartisan Partisan (list political party below) El 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) IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(5) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) rHFCK nKIF FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SUPPORT OPPOSE SUPPORT T OOO PPP PPP❑000555EEE U FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization CALIFORNIA' Recipient Committee • - INSTRUCTIONS ON REVERSE Page 3 COMMIT TEL NAME I.D. NUMBER Maika Llorens Gulati for San Rafael City Council District 1 2020 1425910 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 Sponsored List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE Small Contributor Committee Date qualified 5. Termination Requirements By signing the verification, the treasurer, asslstanttreasurer and/or candidate, officeholder, or proponent 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: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov