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Home My WebLink AboutForm 410 - Davidi for San Rafael City Council 2026; InitialStatement of Organization Recipient Committee Statement Type 0 Initial ❑ Amendment Q) Not yet qualified or 0 Dale qualification threshold met Date qualiffcatlon threshold met I.D. Number H anvurahk) NAME OF COMMITTEE Davidi for San Rafael City Council 2026 STREET ADDRESS (NO P.O. HOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 FALL MAILING ADDRESS (IF DIFFERENT) E-MAIL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL.) COIINIY OF DOMICIL E JURISDICTION WIIERE COMMITTEE IS ACTIVE Marin I San Rafael CA Attach additional information on appropriately labeled continuation sheets. ❑ Termination — See Dale of termination NAME OF TREASURER Aliza Davidl E C"El V E JUN 3 0 2025 ITY CLERK'S OFFIC For Official Use Only STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE San Rafael CA 94901 EMAIL ADDRESS OF TREASURER (REQUIRED) NAME OF ASSISTANT TREASURER, IF ANY STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED( AREA CODE/PHONE NAME OF PRINCIPAL OFFICFR(S) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED) AREA COIIF/PFIONF I have used all reasonable diligence in preparing this statement and to the best of my knowl,,dge the infurmation contained herein is true and comphite. i Lerdfy under penalty of perjlJi y under the laws of the State of California that the foregoing is true and correct, Executed un �� S —Z\laBy DATE nANO-n TF O P�1 n.rnc or RnnnlJruT Executed on DATE Executed on DATE BY SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROL IING OFFICE14010ER, CANOIOATE, OR STATE MEASURE PROPONENT FPPC Form 410 (October/2023) FPPC Advice: advice,@lPgc.n,9ov (866/275-3772) WWW.foRc,ca�Ov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE we Page 2 COMMITTEE NAME I.D. NUMBER Davidi for San Rafael City Council 2026 • 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 ,&Y\ " �G �•t 1� cA I vw� o r'VIZ 1 WQZ40143� ADDRESS O FINANrIIAL INSTITUTION CITY �� O _ STATE tIPCODE ,►� � �� l C Pv C�A (a f • 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 PrimaPrimarily 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 RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. IINCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE )RT OPPOSE S'."PORT OPPOSE 1 FPPC Feim 410 (October/2023) FPPC Advice: advice Rfppcca.gqv (866/275-3772) www.fn0c.ca,J!0 CHECK O.t Daryoush Davidi San Rafael City Council District 3 2026 Nonpartisan Partisan (list political party below( Nonpartisan Partisan (list political party below) PrimaPrimarily 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 RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. IINCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE )RT OPPOSE S'."PORT OPPOSE 1 FPPC Feim 410 (October/2023) FPPC Advice: advice Rfppcca.gqv (866/275-3772) www.fn0c.ca,J!0 Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMN111 TI1 NAME Davidi for San Rafael City Council 2026 General Purpose Committee 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 CommitteeSponsored List additional sponsors on an attachment. NAMF nF connic- 1 qn USi11Y GROUP OR AFFILIATION OF SPONSOR -------.•-�� Page 3 LD NUM 1VV.A1VU]INtt1 CITY STATE ZIP CODE AREACOD[/PHONE Small Contributor❑ Date no o 6-f • 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 Cnde Section 89519. — Leftover -funds of ballot measure committees may be used for political, legislative or.govOmMental purposes under Government Code Sections 89511- 89518, and are subject o Elections Code Section 18680 and FPPC Regulation 18x•1.1.5. FPPC Form 410 (October/2023) FPPC Advice: adv.Ice@fPPc,W.P.ov-(866/275-3772) www.fnac.ca.>;Dv