HomeMy WebLinkAboutForm 410 - Police Association PAC Amend 02-07-25 (State)Statement of Organization Recipient Committee Statement Type i] Initial Ed Amendment Q Not yet qualified or Q Date qualification threshold met Date qualification threshold met 01 / 01 ! 1983 I.D. Number flf annllca6le) B31553 NAME OF COMMITTEE San Rafael Police Association Political Action Committee STREET ADDRESS (NO RO. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 ( FULL MAILING ADDRESS (IF DIFFERENT) San Rafael, CA 94915-1557 E-MAIL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL) COUNTY OF DOMICILE ]JURISDICTION WHERE COMMITTEE IS ACTIVE Marin County, CA Attach additional information on appropriately labeled continuation sheets. Date Stamp Terminatlon -- See Part 5 DIGITALLY G %WofWW- UJ OnlW RECEIVED AND FILED In the office ofthe California Secretary of State Date of termination FEB 12 2025 �) F E B 2 7 2025 NAME OF TREASURER Marissa Carney STREET ADDRESS (NO P.O. BOX) CITY STATE ZI P CODE San Rafael CA 94901 EMAIL ADDRESS OF TREASURER (REQUIRED) AREA CODE/PHONE OF ASSISTANT TREASURER, IF ANY Stacy R. Owens STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE 312 CA 94607 EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED) AREA CODE/PHONE filinge® OF PRINCIPAL OFFICER(S) Christopher. Fuller, Vice President STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE 1520 Rafael CA 94901 EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED) AREA CODE/PHONE filings© 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. Executed an 02/07/2025 By Star \A/P----tnS Digitally signed by Stacy Owens DATE —--iaY/I' R 1 7 ISPki,Y KEASURER Executed on DATE Executed on DATE Executed on DATE nef le.com By SIGNATURE OF CONTROLLING OFFICEIiOLpCR, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE Of CONTROLLING OFFICEFIDLDER, GNDIpATE, OR STATE MEASURE PRO PONE N'f By SIGNATURE OFCONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FFPC Form 410 (October/2023) FPPC Advice: advicef oc,ca.sov (866/275-3772) www.fooc.ca. oo Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE San Rafael Police Association Political Action Committee NAME POSITION Michael Mathis, Preaident Principal officer STREET ADDRESS (NO P.O. BOX) CITY STATEZiP CODE San Rafael CA 94901 E-MAILADDRESS AREA CODE/PHONE ( Page 2 of 4 631553 FPPC Form 410 (October12023) FPPC Advice: advice@fppc.ca.gov (888l276-3772) www.fppc.ca.gov Statement of Organization -_ Recipient Committee INSTRUCTIONS ON REVERSE Page 3 of 4 I.DNUMBER©31553 ,UMMITTEEE NgqME . San Rafael Police Association Political Action Committee • 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 US Bank (415)448-0145 Marissa Carney, Michael Mathis ADDRESS OF FINANCIAL INSTITUTION CITY STATE ZIP CODE 369 3rd Street San Rafael CA 94901 19 r . •. • List the name f 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 ..._.-_-.... .. ...r. ...rri��nnnen/c•r—chAM A C I I D a oOn On Mr MT hnIrl I InF nwTRIrT NUMBER IF APPLICABLE) ELECTION CHECK ONE primcirfly Formed Committee ! Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURES) FULL TrrLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURES) JURISDICTION IPA RECALL, STATE "RECALL" IN FRONT OFTHE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE SUPPORT I OPPOSE SUPPORT I OPPOSE FPPC Form 410 (October/2023) FPPC Advice: A.d—yl�.e fopc.ca.>;ov (866/275-3772) www.fs)pc.ca.gov Statement of Organization 0 - Recipient Committee • - INSTRUCTIONS ON REVERSE I Page 4 of 4 COMMITTEE NAME I.D. NUMBER San Rafael Police Association Political Action Committee 831553 . 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 To make political contributions to support and oppose candidates and issues of interest to the San Rafael Police Association. List additional sponsors on an attachment. NAME OF SPONSOR I INDUSTRY GROUP OR AFFILIATION OF SPONSOR San Rafael Police Association Union STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE 1520 Fifth Avenue San Rafael CA 94901 (415)4B5-3000 ❑ /� 5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, orponentcertify that all ofthe 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 (October/2023) FPPC Advice: adviceMpvc.ca,gov (8661275-3772) w, ww.fD c.ca.gov