HomeMy WebLinkAboutForm 410- Yes on Measure D InitialStatement of Organization
Recipient Committee
Statement Type ❑ Initial ❑ Amendment
List I.D. number:
Not yet qualified 10or
q
❑ Termination —see Part 5
List I.D. number:
ID I [E C 'LE 0 W
MAR 1 0 2016
.1 .1 �.1 1 CITY CLERK'S OFF CE
Date qualified as committee Date qualified as committee Date of Termination
(If appilable)
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF TREASURER
Committee to Support San Rafael Libraries - Yes on Measure
STREET ADDRESS (NO P O BOX)
1000 4th Street, Ste. 600
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael, CA 94901 (
MAILING ADDRESS (IF DIFFERENT)
P.O. Box 150488, San Rafael, CA 94915
FAX / E-MAIL ADDRESS
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Marin I City of San Rafael
Dirck W. Brinckerhoff
STREET ADDRESS (NO P.O BOX)
For Official Use Only
CITY
STATE
ZIP CODE
AREACODE/PHONE
San Rafael
CA
94903
(
NAME OF ASSISTANT TREASURER, IF ANY
Jeffrey Schoppert
STREET ADDRESS (NO P.O BOX)
CITY
STATE
ZIP CODE
AREACODE/PHONE
San Rafael
CA
94901
(
NAME OF PRINCIPAL OFFICERIS)
Jeffrey Schoppert
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets. San Rafael CA 94901 (
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 of California that the foregoing is true and correct.
Executed on Z-6 ( G BY
I DATE
RER OR
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on BY
GATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (tan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
Continuation sheet:
2. Treasurer and Other Principal Officers
Additional Principal Officer:
Glena Coleman
San Rafael, CA 94901 (
California Form 410