HomeMy WebLinkAboutForm 450 - Eli Hill for San Rafael City Council D2; 12-31-24SHORT ORN
Recipient Committee
Campaign Statement - Short Form
SEE INSTRUCTIONS ON REVERSE
For use by recipient committees that have not received a
contribution or other receipt that must be itemized, have not
received or made loans, and have no outstanding accrued
expenses.
1. Type of Recipient Committee:
Ballot Measure Committee
❑ Primarily Formed
❑ Controlled
❑ Sponsored
Primarily Formed Candidate/
Officeholder Committee
3. Committee Information
Statement covers period
from 7/1/24
through
12/31 /24
❑ General Purpose Committee
❑ Sponsored
❑ Small Contributor Committee
Eli Hiil for San Rafael City Council L02 2022
STREET ADDRESS (NO P.O. BOX)
I.D. NUMBER
1439046
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA 94901
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E-MAILADDRESS
I i
Date of election ifP icable:
(Month, Day, lbarf f
2. Type of Statement:
❑ Pre -election Statement
® Semi-annual Statement
❑ Termination Statement
Page - Ii— of 3
For Official Use Onlv
❑ Quarterly Statement
❑ Special Odd -year Report
Amendment (Explain)
(Also check type of statement you are amending)
Treasurer(s)
NAME OF TREASURER
Eli Hill
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA 94901
NAME 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
PROPONENT, OR RESPONSIBLE OFFICER OF SPONSOR
Executed on
DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
FPPC Form 450 (1an/2016)
FPPI Advice: advice@fopc.ca.gov (866/275-3772)
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Recipient Committee
Campaign Statement
Summary Page
Amounts may be rounded
to whole dollars.
from
through
covers
SHORT FORM
Page Z of
D. NUMBER
Expenditures Marie
1. Expenditures of $100 or more made this period......................................................................................................................................
$
0
137.65
2. Expenditures under $100 made this period (Not itemized.).....................................................................................................................
3. SUBTOTAL EXPENDITURES MADE THIS PERIOD..........................................................................................................
Add Lines 1 + 2
$
137.65
4. Nonmonetary Adjustment...........................................................................................................................................
From Line 8 Belong
5. Total expenditures made from previous statement................................................................................
Previous Summary Page, Line 6
$
346
Of this is the first statement for the calendar year, enter zero.)
r
6. t OTAL EXPENDITURES MADE TO DATE..................................................................................................................
Add Lines 3 + 4 + 5
$
483.65
Contributions Received
7. Monetary contributions received this period.............................................................................................................................................
$
0
8: Mon -monetary contributions received this period.....................................................................................................................................
9. Total contributions received from previous statement ................................................ :....................
.... Previous Summary Page, Line 10
$
(lf this is the first statement for the calendar year, enter zero.)
10.TOTAL CONTRIBUTiONS RECEIVED TO DATE.........................................................................................................
Add Lines 7 + 8 + 9
$
0
Current Cash Statement
111. Beginning cash balance......................................................................................................................Previous
Summary Page, Line 15
$
1366.66
12. Cash receipts this period......................................................................................................................................................
Line 7 above
0
13. Miscellaneous increases to cash.............................................................................................................................................................
$
14.Cash expenditures this period..............................................................................................................................................Line
3 above
137.65
15. ENDING CASH BALANCE THIS PERIOD........................................................................Add
Lines 11 + 12 + 13, then subtract Line 14
$
1229.01
FPPC Form 450 (1an/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Recipient Committee Amounts may be rounded
Campaign Statement — Short Form to whole dollars.
SEE INSTRUCTIONS ON REVERSE
NAME OF COMMITTEE
55. Payments Made (if more space is needed, use additional copies of this page for continuation sheets.)
Statement covers period
from
through
SHORTFORM
Page of
NAME OF CANDIDATE AND OFFICE OR
DATE* t
1
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
DESCRIPTION OF PAYMENT
NAME OF BALLOT MEASURE AND
BALLOT NUMBER OR LETTER
AND JURISDICTION
AMOUNT
THIS PERIOD
CUMULATIVE
AMOUNTS TO DATE
Calendar Year
$
Other
$
❑ Support ❑ Oppose
❑ Contribution ❑ Ind. Exp.
Calendar Year.
Other
❑ Support ❑ Oppose
❑ Contribution ❑ Ind. Exp.
$
Calendar Year
Other
$
❑ Support ❑ Oppose
❑ Contribution ❑ Ind. Exp..
SUBTOTAL $
* Required only for payments which are contributions or independent expenditures.
FPPC Form 450(Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov