HomeMy WebLinkAboutForm 410- Andrew McCullough for City Council 2015; Termination; StateStatement of Organization
Recipient Committee
Statement Type ❑ Initial ❑ Amendment
Q Not yet qualified
or
Q Date qualification threshold met Date qualification threshold met
. E I.D. Number 1339798
NAME OF COMMITTEE
NAME OF TREASURER
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McCullough for City Council 2015
Andrew McCullough
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ECITY CLERK'S
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.O. BOX)
E-MAIL ADDRESS (REQUIRED)/FAX (OPTIONAL)
CITY
STATE ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE
IURISDICTION WHERE COMMITTEE IS ACTIVE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
WWI
Attach additional information on appropriately labeled continuation sheets.
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained
penalty of perjury under the laws of the State
CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE ,MEASURE PROPONENT
STATE ZIP CODE AREA CODE/PHONE
n is true and complete. I certify under
FPPC Form 410 (August/2018)
FPPC Advice:.: r_c _:mac_ o; (866/275-3772)
Statement of Organization
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1
Recipient Committee
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INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
LD. NUMBER
McCullough for City Council 2015
1339798
All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
AREA CODE/PHONE
BANK ACCOUNT NUMBER
Bank of Marin
415/485-2265
02342269
ADDRESS
CITY STATE
ZIP CODE
1101 Fourth Street
San Rafael CA
94901
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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
Andrew McCullough
San Rafael City Council
2015
Nonpartisan
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Partisan
(list political party below)
Dem
Nonpartisan
Partisan
(list political party below)
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULLTITLE (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(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410(August/2018)
F P P C Advice: wE.iVice{ c. E_(866/275-3772)
