HomeMy WebLinkAboutForm 410 - Police Association PAC Amend 10-03-25Statement of Organization
Recipient Committee
Statement Type ❑ Initial ® Amendment ❑ Termination — S
Q Not yet qualified
or
Q Date qualification threshold met Date qualification threshold met Date of termina
01 / 01 / 1983
MEI.D. Number
/ifapplicable) 831553
NAME OF COMMITTEE
San Rafael Police Association Political Action Committee
STREET ADDRESS (NO P.O. BOX)
CITY STATE
San Rafael CA
FULL MAILING ADDRESS IF DIFFERENT)
San Rafael, CA 94915-1557
E-MAIL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL)
ZIP CODE AREA CODE/PHONE
94901 (
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Marin County, CA I City of San Rafael
Attach additional information on appropriately labeled continuation sheets.
NAME OF TREASURER
Beth Minka
MOM
For Official Use Only
STREET ADDRESS (NO P.O. BOX) CITY
STATE ZIP CODE
San Rafael
CA 94901
EMAIL ADDRESS OF TREASURER (REQUIRED)
AREA CODE/PHONE
(
NAME OF ASSISTANT TREASURER, IF ANY
Stacy E. Owens
STREET ADDRESS (NO P.O. BOX) CITY
STATE ZIP CODE
Oakland
CA 94607
EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED)
AREA CODE/PHONE
(
NAME OF PRINCIPAL OFFICER(S)
Christopher Fuller, Vice President
STREET ADDRESS (NO P.O. BOX) CITY
STATE ZIP CODE
San Rafael
CA 94901
EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED)
AREA CODE/PHONE
(
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 is true and correct. o,9„a ysly—by—.1-
Beth Minkaoa,e.1ozs,o.o—..:10
Executed on 10/03/202S By
DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER
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
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (October/2023)
FPPC Advice: advice@fppc.ca.sov (866/275-3772)
www.fppc.ca.gov
netfile. com
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME --
San Rafael Police Association Political Action Committee
NAME
POSITION
Michael Mathis, President
Principal Officer
STREET ADDRESS (NO P.O. BOX)
CITY STATEZIP CODE
San Rafael CA 94901
E-MAIL ADDRESS
AREA CODE/PHONE
(
Page 2 of 4
I.D. NUMBER
831553
FPPC Form 410 (October/2023)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME -
San Rafael Police Association Political Action Committee
Page 3 of 4
I.D. NUMBER
831553
• 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
• 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)
• I • 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) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURES) JURISDICTION
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (October/2023)
FPPC Advice: advice@fPPc.ca.gov (866/275-3772)
www.faoc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME --
San Rafael Police Association Political Action Committee
Page 4 of 4
I.D. NUMBER
831553
General • • 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 INDUSTRY GROUP OR AFFILIATION OF SPONSOR
San Rafael Police Association Union
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA 94901 (
Small Contributor Committee
Date
• 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@fPPc.ca.ROV (866/275-3772)
www.fppc.ca.eov