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Home My WebLink AboutForm 410 - Police Association PAC Amend 02-11-26Statement of Organization Recipient Committee Statement Type ❑ Initial ® Amendment O Not yet qualified or Q Date qualification threshold met Date qualification threshold met 01 / 01 / 1983 I.D. Number fifappllcable) 831553 NAME OF COMMITTEE San Rafael Police Association Political Action Committee ❑ Termination —See STREET ADDRESS (NO P.O. BOX) 1520 Fifth Avenue CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 (415)485-3000 FULL MAILING ADDRESS (IF DIFFERENT) P.O. Box 151557 San Rafael, CA 94915-1557 E-MAIL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL) filings@seowenscompany.com COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Marin County, CA I City of San Rafael Attach additional information on appropriately labeled continuation sheets. e5 m Date of termination ' J TY CLERK'S OFFiC NAME OF TREASURER Beth Minka For Official Use Only STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE 1520 Fifth Avenue San Rafael CA 94901 EMAIL ADDRESS OF TREASURER (REQUIRED) AREA CODE/PHONE filings@seowenscompany.com (415)485-3000 NAME OF ASSISTANT TREASURER, IF ANY Stacy E. Owens STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE 312 Clay Street, Suite 300 Oakland CA 94607 EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED) AREA CODE/PHONE filings@seowenscompany.com (510)423-4300 NAME OF PRINCIPAL OFFICER(S) Trevor Carney, Vice President STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE 1520 Fifth Avenue San Rafael CA 94901 EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED) AREA CODE/PHONE filings@seowenscompany.com (415)485-3000 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. Beth Digitally,ig—by .-.1— ID6 026D2.11 Executed on 02/11/2026 By Minka DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER Executed on By DATE Executed on By DATE Executed on SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (ottober/2023) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fgpc.ca.goy netfile. com Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME San Rafael Police Association Political Action Committee NAME POSITION Christopher Fuller, President Principal Officer STREET ADDRESS (NO P.O. BOX) CITY STATEZIP CODE 1520 Fifth Avenue San Rafael CA 94901 E-MAIL ADDRESS AREA CODE/PHONE filingsCseowenscompany.com (415)485-3000 Page 2 of 4 I.D. NUMBER 831553 FPPC Form 410 (October/2023) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppe.Ga.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)448-014S 158201413032 Beth Minka 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.aov (866/275-3772) www.fppc.ca.eov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 4 of 4 COMMITTEE NAME I.D. NUMBER San Rafael Police Association Political Action Committee 831553 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 San Rafael Police Association INDUSTRY GROUP OR AFFILIATION OF SPONSOR Lfnion STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE 1520 Fifth Avenue San Rafael CA 94901 (415)485-3000 ❑ / a - qualified 5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or ponent certify that all of the following conditions have been met: committeeThis • to receive contributions • 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.gov (866/275-3772) www.fppc.ca.gov