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HomeMy WebLinkAboutForm 410- Kate Colin for City Council 2017 Amendment #2Statement of Organization Recipient Committee Statement Type o Initial Not yet qualified D or --1--1-- Dale qualified as committee !t. on NAME OF COMMITTEE j;z) Amendment List I.D . number: # 1357514 ~/~/2013 Date qualified as committee (If applicable) Re-Elect Kate Colin for San Rafael City Council 2017 STREET ADD RESS (NO PO BOX) o Termination -See Part S List I.D . number: #---------- 1 1-- Date of Termination 2. Treasurer a NAME OF TREASURER Richard Kalish STREET ADDRESS (NO P.O. BOX) AUG -1 CITY CLERK'S OF CE rs CITY STATE ZIP CODE San Rafael CA 94901 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER. IF ANY MAILING ADDRESS (IF DIFFER EN T) STREET ADDRESS (NO P.O. BOX) FAX I E-MAil ADDRESS CITY STATE ZI P CO DE COUNTY OF DOMICilE JURISDICT ION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY STATf ZIP CO DE Attach additional information on apprapriately labeled continuation sheets. 3. Verification AREA CODE/PHONE ( AREA CODE /PHONE AREA CODE/PHONE I have used al l 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 Stat f alifornia that the fore and correct. -po->.{J Executed on 07/28/2016 DATE Executed on 07/28/2016 DATE Executed on DATE Executed on DATE By~~~~~~~ __ ~~~~~~~~~~~~~~~ __________________ ___ BY ___ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ _______ __ BY ______________ ~~~~~~~~~~~~~~~~~~~~~~--------------- SIGNATURE OF CONTROLLING OFFICEHOlDER, CANDIDATE , OR STATE MEASURE PROPONENT BY ______________ ~~~~~~~~~~~~~~~~~~~~~~---------------SIGNATURE OF CONTROLLING OFFICEHOlDER , CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE CO MMITIEE NAM E Re-Elect Kate Colin for San Rafael City Council 2017 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE ADDRESS CITY 4. Type of C~~mittee Complete the applicable sections. Controlled Committee BANK ACCOUNT NUMBER STATE ZIP CODE CALIFORNIA 41 0 FORM 1.0. NUMBER 1357514 • 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 Kate Colin San Rafael City Council 2017 Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATEls) 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) PARTY o Nonpartisan o Nonpartisan CHECK ONE FPPC Form 410 (Jan/ZOI6) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Re-Elect Kate Colin for San Rafael City Council 2017 4. Type of Committee (Continued) CALIFORNIA 41 0 FORM 1.0 . NUMBER 1357514 General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election . Check only one box: o CITY Committee 0 COUNTY Committee 0 STATE Committee PROVIDE BRIEF DESCR IP TIO N OF ACTIVITY Sponsored Committee List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE Small Contributor Committee D __ I __ I __ Date qualified S. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the following conditions have bee".. met: • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • This committee has no surplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511 -89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov