HomeMy WebLinkAboutForm 410- Yes on Measure D TerminationStatement of Organization
Recipient Committee
Da :c St a m p CALIFORNIA 41 0
FORM
Statement Type D Initial
Not yet qua lifi ed 0 or
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o Amendment
list I.D. n umber:
It 1383895
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Date q ual ified as committee Dat e q ualified as committee
111.pp .".ble]
1. Committee Information
IZl Termination-See Part 5 RE EiVED AND F:LED
list 1.0 . number: i
It 1383895
08
Date of Termination
n the ffice of the Secretary of State
f the State of California
SEP 0 1 2016
2. Treasurer and Other Principal Officers
NAME OF iREASIw~Eq
Committee to Support San Rafael Libraries -Yes on Measure 0 Dirck W. Brinckerhoff
S,REET A O~RE SS (NO po 30X]
1000 4th Street , Ste. 600 San Rafael CA 94903
c.r"" ZI . COU~ AREA COOEj;:H C !\::
San Rafael CA 94901 ( Jeffrey Schappert
.REET A ju~ESS (~O PO aox]
1000 4th Street, Suite 600
ZIP COuE
NAME 0' PR INCIPAL Of';CER(S]
Marin San Rafael Jeffrey Schappert
STRE ET ADDRESS {~O PO SOX]
CIT V ZIP CODE
Attach additiona l information on appropriately labeled continuation sheets.
San Rafael CA 94901
3. Verification
For OffiCIa l Use On ly
A~::A CODE/?~Of\E
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AiH:A CO:lE/:JrlONE
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A;{f A COJ E/;J~ON E
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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 al ifornia that the foregoing is true and correct.
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Executed on
DAT E
Executed on
CATE
Executed on
~ATE
By
By
By
SIGNATURE Of CONTRCtUNG OffiCEHOLDER. CANDIDATE. OR STATE MEASURE PROPO N ENT
SIGNATURE Of CO'lTROlUNG OFFICEHOLDER. CAND IDATE , OR 5 ATE MEASURE PROPON ENT
SIGNATU~E Of CONTROLLING OfFICH1OLDER, CAN~IDATE . OR STATE I\'EASURE PROPONENT
FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
Termination 8-15-2016
Committee to Support San Rafael Libraries -Yes on Measure 0
Continuation sheet:
2. Treasurer and Other Principal Officers
Additional Principal Officer:
Glena Coleman
San Rafael, CA 94901 (
California Form 410
Page 1-A
10 Number: 1383895
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Committee to Support San Rafael Libraries -Yes on Measure D
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE
Bank of Marin (415)485-2265
ADDRESS CITY
BANK ACCOUNT NUMBER
02345205
STATE ZIP CODE
CALIFORNIA 41 0
FORM
1.0. NUMBER
1383895
1101 4th Street San Rafael CA 94901
4. Type of Committee Complete the applicable sections.
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Controlled Committee
• 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
Primarily Farmed Committee 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 LEITER)
San Rafael Special Library Services Parcel Tax Measure
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
City of San Rafael
PARTY
o Nonpartisan
o Nonpartisan
CHECK ONE
SUPPORT OPPOSE
[l] D sur:l °Ll
FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov