HomeMy WebLinkAboutForm 410 - Police Association PAC Amend 10-03-25 (State)Statement of Organization
Recipient Committee
Statement Type E] Initial ® Amendment
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OF COMMITTEE
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❑ Termination—See
ermination—See al
! CLERK'S OFFICE
01 / 1 1983
_ I.D. Number
San Rafael Police Association Political Action Committee
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA 94901 (
FULL MAILING ADDRESS (IF DIFFERENT)
San Rafael, CA 94915-1557
L-MAIL ADDRESS OF COMMITTEE (REQUIRED}/ FAX (OPTIONAL)
COU
OF
SDICTION WHERE
I Maria Count9y, DOMICILE IJtIRICity of San RafalelEE IS ACTIVE I
Attach additional information on appropriately labeled continuation sheets.
NAME OF TREASURER
Beth Minka
Date Stamp
DIGITALLY
RECEIVED AND FILED
In the office of the CalRorala
Secretary of State
OCT 03 2025
STREET ADDRESS (NO P.O. BOX) CITY
San Rafael
EMAIL ADDRESS OF TREASURER (REQUIRED)
NAME OF ASSISTANT TREASURER, IF ANY
Stacy E. Owens
STREET ADDRESS IND P.O. BOX) CITY
Oakland
EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED)
NAME OF PRINCIPAL OFFICER(S)
Christopher Fuller, Vice President
STREET ADDRESS (NO RO, BOX) CITY
San Rafael
EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED)
For Official Use Only
STATE ZIP CODE
CA 94901
AREA CODE/PHONE
(
STATE ZIP CODE
CA 94607
AREA CODE/PHONE
(
STATE ZIP CODE
CA 94901
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—M.1.3 A...
Beth Minka_o� s.��y"h
Executed on 10/03/2025 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
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (October/2023)
FPPC Advice: advicePfPRc.ca.eov (866/275-3772)
www.fpoc.ca.gov
neffile.com
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
;OMMiTTE E 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
831553
FPPC Form 410 (October(2023)
FPPC Advice: advlce@fppc.ca.gov (8661276-3772)
www.fppo.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
San Rafael Police Association Political Action Committee
Page 3 of 4
E.D. NUMBER
B31553
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 TOOBTAIN BANK RECORDS AREA CODE/PHONE BANK ACCOUNT NUMBER
US Bank
(415)446-0145
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)
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 MEASURE(S) 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.gQv (866/275-3772)
www.fppc.ca.P_ov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 4 of 4
COMMI-TEE NAME I.D, NUMBER
San Rafael Police Association Political Action Committee 831553
Ge
• • ° Not formed to support or appose 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 ND. AND STREET
Small Contributor Committee �
CITY STATE ZIP CODE AREA CODEJPHONE
San Rafael CA 94901 (
t0min4bdnRegUirements By signing theveriftcation; the' treasurer;assistanttrea3�irerand/oreandidate,officeholder,.orponentcerti'Nthatall ofthe foliowngcanditionshove bee nmet: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: advice0fpgc.ca.gov (866/275-3772)
WWW.fPPc.Ca.SoV