HomeMy WebLinkAboutForm 410 - Rachel Kertz for City Council 2024; StaterL
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Statement of Organization L Date Stamp
Recipient Committee '
Statement Type ®Initial ❑ Amendment ❑ Termination — See ����® �� F o al t n y
I he office of the Secretara
Q Not yet qualified c f the State of Calif
or
O Date qualification threshold met Date qualification threshold met Date of termination ' a C P
0� 201 2024 �1 U
LD. Number • . _ •
(//applicable)
NAME OF COMMITTEE NAME OF TREASURER
Committee to Re-elect Rachel Kertz for San Rafael City Council 2024 Tamara Hull
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE
Novato CA 94945
EMAIL ADDRESS OF TREASURER (REQUIRED) AREA CODE/PHONE
STREET ADDRESS (NO P.O. BOX)
NAME OF ASSISTANT TREASURER, IF ANY
CITY STATE ZIP CODE AREA CODE/PHONE n/a
Novato CA 94945 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE
FULL MAILING ADDRESS (IF DIFFERENT)
same EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED) AREA CODE/PHONE
E-MAILADDRESS OF COMMITTEE (REQUIRED)/ FAX (OPTIONAL)
NAME OF PRINCIPAL OFFICER(S)
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Rachel Kertz
Marin City of San Rafael STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE
Novato CA 94945
EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED) AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
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
CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (October/2023)
FPPC Advice: advicePfppc.ca.sov (866/275-3772)
www.fppc.ca.gov
Statement of Organization • ' • " ' ,
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D. NUMBER
Committee to Re -Elect Rachel Kertz for San Rafael City Council 2024
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 1415-472-2265
ADDRESS OF FINANCIAL INSTITUTION CITY STATE ZIP CODE
496 Las Gallinas Avenue #4 San Rafael CA 9490
• 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 (INCI NDF DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
Rachel Kertz
City Council, City of San Rafael, District 4
2024
Nonpartisan
Partisan
(list political party below)
Nonpartisan
Partisan
(list political party below)
E 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 RFCALI. STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410(October/2023)
FPPC Advice: advice fppc.ca.eov (866/275-3772)
www.fppc.ca.eov