HomeMy WebLinkAboutForm 410- Gary Phillips for Mayor 2015 InitialZ�
Statement of Organization
Recipient Committee
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Statement Type m Initial ❑ Amendment ❑ Termination — See Part 5
Not yet qualified ® or LSt I.D. number: Lest I.D. number:
Date qualified as committee Date qualified as committee Date of Termination
(IFapplkable)
NAME OF COMMITTEE
Gary Phillips for Mayor 2015
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA 94901 (
MAILING ADDRESS (IF DIFFERENT)
FAX / E-MAIL ADDRESS
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Marin San Rafael
Attach additional information on appropriately labeled continuation sheets.
NAME OF TREASURER
Richard Kalish
STREET ADDRESS (NO P.O. BOX)
Date Stamp
For Oficial Use Only
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V111 `' 3 £ City of San 9afael
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA 94901 (
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
NAME Or PRINCIPAL OFFICERS)
STREET ADORESS(NO PO. BOX)
CITY STATE ZIP CODE AREACODE/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 S o alif is that th 7eo*,ng is a and correct.
Executed on 03/26/2015 By e+
DATE SIGNATURE OF TRrASUP.FR CH ,tis -ANT TREASURER
Executed on 03/26/2015 By -
DATE
Executed on 8)
DATE
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Dec/2012)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Gary Phillips for Mayor 2015
• All committees must list the financial institution where the campaign bank account Is located.
NAME OF FINANCIAL INSTITUTION AREACODE/PHONE BANK ACCOUNT NUMBER
Bank of Marin (415)485-2265
ADDRESS CITY STATE ZIP CODE
1101 Fourth Street San Rafael CA 94901
Page 2
1 G NUMBER
• 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."
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME OF CAN MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Gary Phillips
Mayor, City of San Rafael
2015
® Nonpartisan
SUPL JT
❑ Nonpartisan
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
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
FPPC Form 410 (Dec/2012)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppr-ca.gov
SUPPORT
:
OPPOSE
SUPL JT
o
FPPC Form 410 (Dec/2012)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppr-ca.gov