HomeMy WebLinkAboutForm 410- John Gamblin for City Council 2015 AmendmentStatement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ❑ or
Date qualified as committee
1. Committee Information
NAME OF COMMITTEE
■ Amendment
List I.D. number:
# 3-78282
3 /Zel5
Date qualified as committee
(If appacable)
❑ Termination — See Part 5
List I.D. number:
Date of Termination
Gamblin for City Council 2015
STREET ADDRESS IND P.O. BOX)
CITY STATE ZIP CODE AREA CO DE/PHONE
San Rafael CA 94903 (
MAILING ADDRESS (IF DIFFERENT)
FAX/ E MAIL ADDREz-5
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Marin I City of San Rafael
Attach additional information on appropriately labeled continuation sheets.
2. Treasurer and Oth
NAME OF TREASURER
Date Stamp
For Official Use Only
RECEIVED AND F1
In the office of the Secretary (
of the State of California
John P. Fronefield
STREET ADDRESS (NO P.O. BOX)
I'Y
JUL 0 6 2015
STATE ZIP CODE AREA CODE/PHONE
West Sacramento CA 95691 (
NAME OF A55.STANT TREASURER, IF ANY
John Gamblin
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA 94903 (
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
3. Verification
I have used all reasonable diligence in preparing this statement and -;o the b 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�t elf oWand correct.
�fJ(��5
Executed on -UBy ,
SDATE 5 GNATU RE OF TREASURER OR ASSISTANT-REASURER
Executed on O I By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
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
Page 2
COMMITTEE NAME
I.D. NUMBER
Gamblin for City Council 2015 11378282
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
Wells Fargo Bank
ADDRESS
AREA CODE/PHONE
(916)376-5680
CITY
BANK ACCOUNT NUMBER
STATE ZIP CODE
2140 Town Center Plaza West Sacramento CA 95691
4. Type of Committee 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
John Gamblin
San Rafael City Council
2015
® Nonpartisan
SUT
❑ Nonpartisan
Primarily formed to support or oppose specific candidates or measures in a Single election. List below:
CAN 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)
FPPC Form 410 (Dec/2012)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
El
SUT
OPPOSE
FPPC Form 410 (Dec/2012)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov