HomeMy WebLinkAboutForm 460- Police Association PAC (2016-05-21)Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from 01/01/2016
through _..:0:.:5:J./.=2:.:1C.!../..=2..=O.:::1.:::6 ___ _
1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4.
3.
o Officeholder, Candidate Controlled Committee o State Candidate Election Committee o Recall
(Also Complele Pari 5)
[jJ General Purpose Committee
® Sponsored o Small Contributor Committee o Political Party/Central Committee
o Primarily Formed Ballot Measure
Committee o Controlled o Sponsored
(Also Comp/ele Pari 6)
o Primarily Formed Candidate/
Officeholder Committee
(Also Complele Pari 7)
San Rafael Police Association Political Action Committee
STREET ADDRESS (NO P.O. BOX)
1520 Fifth Avenue
CITY STATE ZIP CODE
San Rafael CA 94901
MAILING ADDRESS (IF DIFFERENT) NO . AND STREET OR P.O. BOX
P .O . Box 151557
CITY
San Rafael
OPTIONAL : FAX / E-MAIL ADDRESS
STATE
CA
ZIP CODE
94915-1557
AREA CODE/PHONE
(415)485-3000
AREA CODE/PHONE
4. Verification
Date of election if appIi1~at'le:
(Month, Day, Year) I;vl'iii=:n-;;;n-;~~-;J.~::J~~;===..:'::'..:;~::::==-l
06/07/2016
2. Type of Statement:
00 Preelection Statement o Semi-annual Statement o Termination Statement
(Also file a Form 410 Termination)
o Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
Ms . Beth Minka
MAILING ADDRESS
1520 Fifth Avenue
CITY
San Rafael
NAME OF ASSISTANT TREASURER. IF ANY
MS . Stacy E. Owens
MAILING ADDRESS
5940 College Avenue
CITY
Oakland
OPTIONAL: FAX / E-MAIL ADDRESS
STATE
CA
STATE
CA
o Quarterly Statement o Special Odd-Year Report o Supplemental Preelection
Statement -Attach Form 495
ZIP CODE
94901
ZIP CODE
94618
AREA CODE/PHONE
(415)485-3000
AREA CODE/PHONE
(510)652-1000
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowl
under penalty of perjury under the laws of the State of California that the foregoing is true and correct. •
ed herein and in the attached schedules is true and complete. I certify
Executed on ___ o_5...;/'-2_6....;/;:;:2:;:0:-1-6------
Date
Executed on ___ 0.::.;5:;.;/:..;2;;.;6:..:/,,;2;,;0;..;1;..;6~ ____ _
Date
Executed on -----~Da:;:te:-------
Executed on ------;;:Da:;:te:-------
www.netfile.com
BY~~tr+rr\rffi~~~~~~~~~~~~------~,
By _________ -.~~~~~~~~~~~~~~~~~-----------Signature 01 Controlling OffICeholder. Candidate. State Measure Proponent
By ______ ~~~~~~~~~~~~~~~~~~-------SIgnature of Controlling OffICeholder. Candidate. State Measure Proponent
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3n2)
www.fppc.ca.gov