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Home My WebLink AboutForm 460 - Maribeth Bushey for Council D3 2022; 01-14-2026 (termination)Recipient Committee Campaign Statement Cover Page Statement covers period from 01/01/2026 SEE INSTRUCTIONS ON REVERSE through 01/13/2026 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. m Officeholder, Candidate Controlled Committee State Candidate Election Committee Recall (Abo Complete Part 5) ❑ General Purpose Committee ❑ Sponsored 8 Small Contributor Committee Political Party/Central Committee ❑ Primarily Formed Ballot Measure Committee Controlled Sponsored (Alm Complete Part 6) ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information I D. NUMBER 1452093 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Re -Elect Maribeth Bushey San Rafael City Council District 3 2022 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE San Rafael CA 94901 ( MAILING ADDRESS (IF DIFFERENT) NO AND STREET OR P.O BOX CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX/E-MAIL ADDRESS COVER PAGE Date of election if applicabl JA N 1 4 2026 A of s (Month, Day, Year) F r Official use Only CITY CLERK'S OFF CE 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement ❑ Semi-annual Statement ❑ Special Odd -Year Report m Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Mark L. Kyle MAILING ADDRESS STATE ZIP CODE AREACODE/PHONE San Rafael CA 94901 ( NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge th i f certify under penalty of P jury un eerr�thhee laws of the State of California that the foregoing is true and on a e BY Signature OT Controlling ORiceholtler, Candidate, State Measure rroponen[ Executed on Date BY Signature of Controlling Officeholder, Candidate, Stale Measure Proponent FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Maribeth Bushey OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council Member, City of San Rafael, District 3 RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael CA 94901 Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. I.D.NUMBER NAME OF TREASURER ❑ YES ❑ NO COMMITTEE ADDRESS STREET Gliy STATE ZIP CODE AREACODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NOP.O BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 Page 2 of 5 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER I JURISDICTION I ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO IF ANY 7. Primarily Formed Candidate/Officeholder Committee Listnames of ofl7ceholder(s) orcandidatefs) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets /f necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded Summary Page to whole dollars. Statement covers period from 01101 2026 SUMMARY PAGE through 01/13/2026 Page 3 of 5 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I D. NUMBER Re -Elect Maribeth Bushy, San Rafael City Council, District 3, 2022 1452093 Contributions Received Column A TOTAL THIS PERIOD Column B Calendar Year Summary for Candidates (FROMATTACHEDSCHEDULES) CALENDAR YEAR TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions................................................... Schedule A, Line $ 0.00 $ 0.00 0.00 0.00 1/1 through 6/30 7/1 to Date 2. Loans Received................................................................ schedule 8, Line 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 $ 0.00 $ 0.00 Contributions 20. Received $ $ 4. Nonmonetary Contributions ............................................ schedule C, Line 3 0.00 0.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3+4 $ 0.00 $ 0.00 Made $ $ Expenditures Made 6. Payments Made ................... ScheduleE, Line $ 563,01 $ 563.01 7. Loans Made................................................................ ScheduleH, Line 0.00 0.00 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 563.01 $ 563.01 9. Accrued Expenses (Unpaid Bills) ....... .............................. schedule F Line 3 0.00 0.00 10. Nonmonetary Adjustment .............................................. .. schedule C, Line 3 0.00 0.00 11. TOTAL EXPENDITURES MADE ........................... Add Lines 8+ 9+ 10 $ 563.01 $ 563.01 Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Line 16 $ 563.01 To calculate Column B, 13. Cash Receipts ....................... Column A, Line above 0.00 add amounts in Column 0.00A to the correspondingamounts 14. Miscellaneous Increases to Cash .................................. scheduler, Line 4 from Column B 15. Cash Payments .............................. ... Column A, Line 8 above """"""""""" 563.01 of your last report. Some amounts in Column A may 16. ENDING CASH BALANCE ............Add Lines 12 + 13 + 14, then subtract Line 15 $ 0 (� be negative figures that should be subtracted from If this is a termination statement, Line 16 must be zero. previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED ................"""'......... Schedule 13, Part2 $ 0•00 filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ see instructions on reverse $ 0.00 any). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made" (B Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) 'Amounts in this section may be different from amounts reported in Column B. 19. Outstanding Debts .......... ...... _.. Add Line 2 + Line 9 in Column B above $ 0.00 I I FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule D SCHEDULE D ♦7u111111AI y W1 GAtivilu1lu1C5 Hrnvums mdy ue rvunae° Statement covers period Supporting/Opposing Other to whole dollars. CALIF_ NIA 460 Candidates, Measures and Committees 01/01/2026 •• from through 01/13/2026 4 5 SEE INSTRUCTIONS ON REVERSE Page of NAME OF FILER I.D. NUMBER Re -Elect Maribeth Bushy, San Rafael City Council, District 3, 2022 1452093 NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE PER ELECTION DATE MEASURE NUMBER OR LETTER AND JURISDICTION, TYPE OF PAYMENT (IF REQUIRED) PERIOD CALENDAR YEAR TO DATE OR COMMITTEE (JAN 1 - DEC. 31) (IF REQUIRED) ® Monetary 01/06/2026 Daryoush Davidi, San Rafael City Council, Contribution $130.52 $130.52 $130.52 - P26 District 3, 2026. FPPC# 1482202 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure El Monetary OV08/2026 Robert Sandoval for San Rafael City Council Contribution $125.00 $125.00 $125.00 - P26 District 3, 2026. FPPC# 1480015 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ 255.52 Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.)....................................................... $ 2. Unitemized contributions and independent expenditures made this period of under$100.................................................................................... $ 255.52 0.00 3. Total contributions and independent expenditures made this period. Add Lines 1 and 2. Do not enter on the Summary Page.) 255.52 P p P ( rY 9 ) .......... TOTAL.. $ FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Amounts may be rounded Payments Made to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Re -Elect Maribeth Bushey, San Rafael City Council, District 3, 2022 Statement covers period from 01/01/2026 through 01/13/2026 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. SCHEDULE E e • , O, 1 Page 5 of 5 .D NUMBER 1452093 CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (Internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Daryoush Davidi, San Rafael City Council, District 3, 2026. FPPC# 1482202 CTB Robert Sandoval for San Rafael City Council District 3, 2026. FPPC# 1480015 I CTB Law Office of Mark Kyle PRO contribution 1 130.52 contribution 1 125.00 307.49 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 563.01 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.).................................................................... 2. Unitemized payments made this period of under$100................................................................................................. 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).).................................... 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... $ 563.01 $ 0.00 $ 0.00 .... TOTAL $ 563.01 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov