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Home My WebLink AboutForm 410 - San Rafael Public Library Foundation (501(c)(3)) TerminationStatement of Organization ® � ® 1 Recipient Committee FORM Statement Type Initial �� /�.rY3endCi9erBt � �'errroir➢at@Ort — S0 5 S E 2u25) 5 — For Official Use Only O Not yet qualified or O Date qualification threshold met Date qualification threshold met Date ofterminati n C! CLERK'S OFFICE 06 / 30 2025 ® m I.D. Number (if applicable) NAME OF COMMITTEE NAME OF TREASURER Charles Stuckey San Rafael Public Library Foundation (Non -Profit, 501(c)(3)) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE San Rafael CA 94901 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 Charles Litchfield San Rafael CA 94901 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE FULL MAILING ADDRESS (IF DIFFERENT) San Rafael CA 94901 San Rafael, CA 94901 EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED) AREA CODE/PHONE E-MAiL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL) NAME OF PRINCIPAL OFFICER(S) COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Marin Mann STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED) AREA CODE/PHONE 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 herein is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By - P EN' DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATI, OR SATE MEASURc. RO ON � FPPC Farrss 410 ((3ctober/2023) FPPC Advice: advice@fnDL.ca.gov (866/275-3772) ww. Jopc.ca.gov Statement of Organization .Z IA14 Committee Recipient FORM INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER San Rafael Public Library Foundation (Non -Profit, 501(c)(3)) 1467937 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 Bank of Marin - Charles Litchfield, Charles Stuckey ADDRESS OF FINANCIAL INSTITUTION 1101 4th St. AREA CODE/PHONE CITY San Rafael 415-485-2265 BANK ACCOUNT NUMBER STATE ZIP CODE CA 94901 • 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 Nonpartisan Partisan (list political party below) Nonpartisan Partisan (list political party below) Primarily Formed Committee 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) CAN DIDATE(S) OFFICE SOUGHT OR HELD OR MEASURES) JURISDICTION M A RFrAI I CTATF °RFr`AI I" IN PRnNT nF THE nFFICFH0I.DER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE Measure P, City of San Rafael, November, 2024 Election SUPPORT OPPOSE SUPPORT OPPOSE FPPC Form 410 (October/2023) FPPC Advice: advice fnRc.ca.gov (866/275-3772) ae% fw.fP0c.ca.geV Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE r1467937 COMMITTEE NAME San Rafael Public Library Foundation (Non -Profit, 501(c)(3)) .. Not formed to support or oppose specific candidates or measures in a single election. Check only one box: CITY Committee F-1 COUNTY Committee El STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY MPO: San Rafael Public Library Foundation was formed to support the mission of building a new library for San Rafael • • �• List additional sponsors on an attachment. NAME OF SPONSOR JINDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE Small Contributor Committee v "" a, "urn si# ' treyurerwd%iirtdfsiate� rlflilder, argwrertfjr xhat att of tie fisFlwi ccsr��F+tians #> a e �e exi. , 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: advice@fpoc.ca.gov (866/275-3772) +svWWJPac.ca.gov