HomeMy WebLinkAboutForm 410- Andrew McCullough for City Council 2015 AmendmentStatement of Organization
Recipient Committee
Statement Type ❑ Initial
Nat yet qualified ❑ or
Date qualified as committee
1. Committee�information i � t-, -
NAME OF COMMITTEE
McCullough for City Council 2015
STREET ADDRESS (NO PO. BOX)
STATE ZIP CODE AREA CODE/PHONE
San Rafael CA 94901 (
MAILING ADDRESS (IF DIFFERENT)
FAX / E-MAIL ADDRESS
COUNTY OF DOMICILE IURISDICTION WHERE COMMITTEE 15 ACTIVE
Marin San Rafael
Date Stamp
RECEIVED AND FI#
in the office of the Secretary of
of the State of California
MAY 212015
For Official Use Only
JUIN - 5 2015
Time:
tv CI9rk's Offi
r -;W of San Raffia
2. Treasurer and Other
Principal Officers
NAME OF TREASURER
Jeffrey Schoppert
STREET ADDRE55 (NO P.O. BOX)
CITY STATE ZIP CODE
AREA CODE/PHONE
San Rafael CA 94901
(
NAME OF A551STANT TREASURER, IF ANY
Andrew McCullough
STREET ADDRESS IND PO BOX)
CITY STATE ZIP CODE
AREA CODE/PHON-
San Rafael CA 94901
(
NAME OF PR JJCIPAL OFFICER(S)
Attach additional information on appropriately labeled continuation sheets. STREET ADDRESS (NO PO. BOX)
CITY
STATE ZIP CODE AREA CODE PF NE
3. Verification
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 California that the foregoing is true and correct.
Executed ur
on J ((p 97 By
y✓/ ATE SIG NATURE OFTREASURERORASSISTANT TREASURER
Executed on v ` B
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
Executed on
DATE
By
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
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 OrganizationWM., Recipient CommitteeE
INSTRUCTIONS ON REVERSE
San Rafael City Council
2015
Page 2
COMMITTEE NAME
I D. NUMBER
McCullough for City Council 2015
1339798
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION I AREA CODE. -PHONE BANK ACCOUNT NUMBER A-711 1
Bank of Marin
ADDRESS
(415)485-2251
CITY
STATE ZIP CODE
1101 Fourth Street San Rafael CA 94901
�,.. - -
4. Typewf Comir�littee Complete the applicable sections.
• 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 CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Andrew McCullough
San Rafael City Council
2015
Z Nonpartisan
suPPORr
❑ Nonpartisan
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) NAME OR MEASURES) FULL TITLE (INCLUDE BALLOT N0. OR LETTER) CANDIDATES) 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.fppc.ca.gov
SUPPORT
OI7P'P05E�
suPPORr
o�p�GF
FPPC Form 410(Dec/2012)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov