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Home My WebLink AboutForm 460 - Carolina Martin for San Rafael School Board Trustee 2022; TerminationRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Statement covers period from 07/01/2024 SEE INSTRUCTIONS ON REVERSE Ithrough 09/30/2024 1. Type of Recipient Committee: All Committees— Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee O Recall O Controlled (Also Complete Part 5) O Sponsored (Also Complete Part 6) ❑ General Purpose Committee O Sponsored ❑ Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee O Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I I.D. NUMBER 1449397 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Carolina Martin for San Rafael City Schools District 4 2022 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Lakeport CA 95453 ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS F[E [E 9 nD Date of election if #)t ble:(Month, Day, 4 _ ;" ��7 i Page 11/08/2 2. Type of Statement: ❑ Preelection Statement ❑ Semi-annual Statement ® Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) COVER PAGE .IFUK 46 U : ORMNIA For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement - Attach Form 495 NAME OF TREASURER Chelsea Johnson MAILING ADDRESS 371 STATE ZIP CODE AREA CODE/PHONE Lakeport CA 95453 (916) OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE 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. 10/03/2024 C6d&w 9cAti By Executed on n,.-.�.,,��,�„�„loa i. �oxaz�z;aun Date Signature of Treasurer or Assistant Treasurer 10/03/2024 C V-01LlaMGY�lh Executed on By 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 (866/275-3772) www.fppc.ca.gov www.netfile.com Recipient Committee Campaign Statement Cover Page — Part 2 COVER PAGE -PART 2 CALIFORNIA O 1 FORM Page 2 of 5 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Carolina Martin OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT Board of Education City of San Rafael District 4 ❑ OPPOSE RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Identify the controlling officeholder, candidate, or state measure proponent, if any. San Rafael CA 94901 NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT 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 OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEENAME I.D. NUMBER 7. Primarily Formed Candidate/Officeholder Committee Listnamesof NAME OF TREASURER CONTROLLED COMMITTEE? officeholder(s) or candidate(s) for which this committee is primarily formed. ❑ 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 STREET ADDRESS (NO P.O. BOX) 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 CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov www.netfile.com Campaign Disclosure Statement SUMMARYPAGE Summary Page Amounts may be rounded to Whole dollars. Statement covers period � - L9 from 07/01/2oz4 SEE INSTRUCTIONS ON REVERSE through 09/30/2024 Page 3 of 5 NAME OF FILER I.D. NUMBER Carolina Martin for San Rafael City Schools District 4 2022 1 1449397 Contributions Received Column Column B Calendar Year Summary for Candidates TOTALTHISPERIOD (FROMATTACHED SCHEDULES) CALENDARYEAR TOTALTODATE Running n Both the State Primary and g Iy General Elections 1. Monetary Contributions ........................................... schedule A, Line 3 $ 0.00 $ 0.00 1/1 through 6/30 7/1 to Date 2. Loans Received...................................................... Schedule a, Line 3 0.00 0.00 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 $ 0.00 $ 0.00 20. Contributions Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 0.00 0.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3+4 $ 0.00 $ 0.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made ....................................................... Schedule E, Line 4 $ 7,552.17 $ 9, 505.67 Candidates 7. Loans Made............................................................. Schedule H, Line 3 0.00 0.00 22. Cumulative Expenditures Made* 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ 7,552.17 $ 9,505.67 (IfSubjectto Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ............................... Schedule FLine 3 0.00 0.00 Date of Election Total to Date 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 0.00 0.00 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE ........................... ..... Add Lines 8+9+10 $ 7,552.17 $ 9,505.67J $ Current Cash Statement $ 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 7,552.17 To calculate Column B, add 13. Cash Receipts ................................................... Column A, Line 3 above 0.00 amounts in Column A to the 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 0.00 corresponding amounts from Column B of your last *Amounts in this section may be different from amounts reported in Column B. 15. Cash Payments .................................................. Column A, Line 8above 7,552.17 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 0.00 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED ........................... Schedule a, Part $ 0.00 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2, 7, and 9 (if any). 18. Cash Equivalents ........................................ See instructions on reverse $ 0.00 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column 8 above $ 0.00 FPPC Form 460 (Jan12016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov www.netfile.com Schedule E Payments Made Amounts may be rounded to whole dollars. Statement covers period from 07/01/2024 SEE INSTRUCTIONS ON REVERSE through 09/30/2024 Page 4 of 5 NAME OF FILER I.D. NUMBER Carolina Martin for San Rafael City Schools District 4 2022 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) E NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID CJ & Associates, Inc. PRO 142.49 Lakeport, CA 95453 CJ & Associates, Inc. PRO 165.00 Lakeport, CA 95453 CJ & Associates, Inc. PRO 557.68 Lakeport, CA 95453 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 865.17 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. 7,552.17 2. Unitemized payments made this period of under$100.......................................................................................................................................... $ 0.00 3. Total interest paid this period on loans. Enter amount from Schedule B, Part 1, Column e . 0.00 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. TOTAL $ 7,552.17 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov www.netfile.com Schedule E SCHEDULE E (CONT.) period Continuation Sheet) Amounts may be rounded Statement covers pCALIFORNIA � • ' Payments Made to whole dollars. from 07/01/2024 •' 09/30/2024 SEE INSTRUCTIONS ON REVERSE through Page s of 5 NAME OF FILER I.D. NUMBER Carolina Martin for San Rafael City Schools District 4 2022 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 RAID 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 FND 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) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Glenwood School Foundation 160 Rafael, CA 94901 CVC 3,437.00 Marin Foster Care 5S Rafael, CA 94903 CVC 3,250.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 6, 687.00 www.netfile.com FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov