HomeMy WebLinkAboutForm 460- Yes on Measure D (2016-08-15)Recipient Committee
Campaign Statement
Cover Page
COVER PAGE
!!IIIIII!!II!II!!IIIIIIIJII
Statement covers period
from ____ 7_-_1_-2_0_1_6 __
Date of election if aplpli(:ab't~
(Month, Day, Year) AUG 25 2016 For Official Use Only
SEE INSTRUCTIONS ON REVERSE 8-15-2016 through ________ _ 6-7-2016
1. Type of Recipient Committee: All Committees -Complete Parts 1,2,3, and 4. 2. Type of Statement:
3.
o Officeholder, Candidate Controlled Committee 121 Primarily Formed Ballot Measure
Committee o State Candidate Election Committee o Recall
(Also Complele Part 5)
o General Purpose Committee o Sponsored o Small Contributor Committee o Political Party!Central Committee
o Controlled o Sponsored
(Also Complele Part 6)
o Primarily Formed Candidate!
Officeholder Committee
(Also Complele Part 7)
I.D. NUMBER
1383895
Committee to Support San Rafael Libraries -Yes on Measure D
STREET ADDRESS (NO P.O. BOX)
1000 4th Street, Ste. 600
CITY
San Rafael
STATE ZIP CODE
CA 94901
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
P.O. Box 150488
CITY
San Rafael
OPTIONAL: FAX I E-MAIL ADDRESS
STATE ZIP CODE
CA 94915
AREA CODE/PHONE
(
AREA CODE/PHONE
(
o Preelection Statement
o Semi-annual Statement
[;lJ Termination Statement
(Also file a Form 410 Termination)
o Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
Dirck W. Brinckerhoff
MAILING ADDRESS
CITY
San Rafael
NAME OF ASSISTANT TREASURER, IF ANY
Jeffrey Schappert
MAILING ADDRESS
CITY
San Rafael
OPTIONAL: FAX I E-MAIL ADDRESS
o Quarterly Statement
o Special Odd-Year Report
STATE ZIP CODE AREA CODE/PHONE
CA 94903 (
STATE ZIP CODE AREA CODE/PHONE
CA 94901 (415) 755-2178
4. Verification
I have used all reasona ble diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete.
certify under penalty o. f pe~ury under the ~ws of th~ State of California that the foregoing is true and:2flrect. ."
Executed on A-uA<d ,.1-: Z..') 2e)L" By ----{~;(Lt~rJt.=::::;;;;;::;:~;:;:;;_;=:::::::__--------~ ;rate I b Signature of Treasurer or Assistant Treasurer
Executed on ------::D:-a,-"te------
Executed on ------::D:-a:-te------
Executed on ------;:D:-a:-te------
By_~~ __ ~~~~~~~~~~~~~~~~~~~~~~~~~Signature of Controlling Officeholder. Candidate. State Measure Proponent or Responsible Officer of Sponsor
By _____ ~~ __ ~~~~~~~~~~~~~~~=_-----Signature of Controlling Officeholder. Candidate, State Measure Proponent
By-----~~~~~~~~~~~~~~~n====_----Signature of Controlling Officeholder. Candidate, State Measure Proponent
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Recipient Committee
Campaign Statement
Cover Page -Part 2
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP
Related Committees Not Included in this Statement: Ust any committees
not included in this statement that are controlled by you or are primarily formed to receive
contributions or make expenditures on behalf of your candidacy.
COMMITIEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITIEE?
DYES o NO
COMMITIEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITIEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITIEE?
DYES o NO
COMMITIEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COVER PAGE -PART 2
"'IIJIJ!II~
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
San Rafael Special Library Services Parcel Tax Measure D
BALLOT NO. OR LEDER
D
JURISDICTION
City of San Rafael
~ SUPPORT o OPPOSE
Identify the controlling officeholder, candidate, or state measure proponent, If any.
NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT
OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY
7. Primarily Formed Candidate/Officeholder Committee Ustnames of
officeholder(s) or candidate(s) for which this committee is primarily formed.
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD D SUPPORT o OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE
Attach continuation sheets if necessary
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Committee to Support San Rafael Libraries -Yes on Measure D
Contributions Received
1. Monetary Contributions ............. ...................................... Schedule A, Une 3
2. Loans Received ................................................................ Schedule B, Line 3
3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Unes 1 + 2
4 . Nonmonetary Contributions............................................ Schedule C, Une 3
5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 + 4
Expenditures Made
6 . Payments Made................................................................ Schedule E, Une 4
7. Loans Made....................................................................... Schedule H, Une 3
B. SUBTOTAL CASH PAyMENTS .......................................... Add Lines 6 + 7
9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F. Line 3
10. Nonmonetary Adjustment... ...................................................... Schedule C, Une 3
$
$
$
$
$
11 . TOTAL EXPENDITURES MADE ........................................ Add Lines B + 9 + 10 $
Current Cash Statement
12. Beginning Cash Balance ............................ Previous Summary Page, Une 16 $
13. Cash Receipts ........................................................... Column A, Une 3 above
14. Miscellaneous Increases to Cash .................................. Schedule I, Une 4
15. Cash Payments ......................................................... Column A . Une B above
16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, then subtract Une 15 $
If this is a termination statement, Une 16 must be zero.
17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part 2 $
Cash Equivalents and Outstanding Debts
1 B. Cash Equivalents ................................................ See instructions on reverse $
19 . Outstanding Debts .............................. Add Une 2 + Une 9 in Column B above $
Amounts may be rounded
to whole dollars.
ColumnA
TOTAL THIS PERIOD
(FROM ATIACHED SCHEDULES)
o
o
o
o
o
331
o
331
o
o
331
266
65 .00
331
o
o
o
o
SUMMARY PAGE
Statement covers period
,
CALIFORNIA 460
FORM 7-1-2016 from _________ _
3 5 8-15-2016 through ________ _ Page ___ of __ _
$
$
$
$
$
$
Column B
CALENDAR YEAR
TOTAL TO OATE
41,307
o
41,307
382
41,689
41,372
o
41,372
o
382
41,754
To calculate Column B ,
add amounts in Column
A to the corresponding
amounts from Column B
of your last report. Some
amounts in Column A may
be negative figures that
should be subtracted from
previous period amounts. If
this is the first report being
filed for this calendar year,
only carry over the amounts
from Lines 2, 7, and 9 (if
any).
1.0. NUMBER
1383895
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
111 through 6/30 7/1 to Date
20. Contributions
Received $ _____ _ $-----
21 . Expenditures
Made $ _____ _ $-----
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made·
(If Subject to Volunlary EApendlt ure Urnlt)
Date of Election
(mm/dd/yy)
Total to Date
$-----
$-----
·Amounts in this section may be different from amounts
reported in Column B .
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule E
Payments Made
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Amounts may be rounded
to whole dollars.
Committee to Support San Rafael Libraries -Yes on Measure D
Statement covers period
from ___ 7_-1_-_2_01_6 __ _
through __ 8_-_1_5_-2_0_1_6 __
SCHEDULE E
CALIFORNIA 460
FORM
Page _4 __ of_5 __
I.D . NUMBER
1383895
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CMP
CNS
CTB
CVC
FIL
FND
IND
LEG
LIT
campaign paraphernalia/misc.
campaign consultants
contribution (explain nonmonetary)·
civic donations
candidate filinglballot fees
fundraising events
independent expenditure supporting/opposing others (explain)·
legal defense
campaign literature and mailings
NAME AND ADDRESS OF PAYEE
(IF COMMITIEE. ALSO ENTER 1.0. NUMBER)
four waters media, inc.
3093 Lassen Street
West Sacramento, CA 95691
MBR
MTG
OFC
PET
PHO
POL
POS
PRO
PRT
member communications
meetings and appearances
office expenses
petition circulating
phone banks
polling and survey research
postage, delivery and messenger services
professional services (legal, accounting)
print ads
CODE OR
CNS
* Payments that are contributions or independent expenditures must also be summarized on Schedule D .
Schedule E Summary
RAD
RFD
SAL
TEL
TRC
TRS
TSF
VOT
WEB
radio airtime and production costs
returned contributions
campaign workers' salaries
t.v. or cable airtime and production costs
candidate travel, lodging, and meals
staff/spouse travel, lodging, and meals
transfer between committees of the same candidate/sponsor
voter registration
information technology costs (internet, e-mail)
DESCRIPTION OF PAYMENT AMOUNT PAID
331
SUBTOTAL $ 331
331 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................................................. $ _____ _
o 2. Unitemized payments made this period of under $100 .......................................................................................................................................... $ _____ _
o 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ............................................................................. $ _____ _
331 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ _____ _
FPPC Form 460 (Jan/20I6)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule I
Miscellaneous Increases to Cash
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Committee to Support San Rafael Libraries -Yes on Measure D
DATE
RECEIVED
FULL NAME AND ADDRESS OF SOURCE
(IF COMMITTEE. ALSO ENTER 1.0. NUMBER)
Attach additional information on appropriately labeled continuation sheets.
Schedule I Summary
Amounts may be rounded
to whole dollars. Statement covers period
from ___ 7_-_1-_2_0_1_6 __ _
through __ 8_-_1_5-_2_0_1_6 __
DESCRIPTION OF RECEIPT
SUBTOTAL $
1. Itemized increases to cash this period ............................................................................................................................ $ _______ 0
2. Unitemized increases to cash of under $100 this period ................................................................................................. $ ______ 6_5
3 . Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ....................................... $ ______ 0
4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the
Summary Page, Line 14.) ............................................................................................................................. TOTAL $ _____ 65_
SCHEDULE I
CALIFORNIA 460
FORM
Page _5 __ of_5 __
I.D. NUMBER
1383895
AMOUNT OF
INCREASE TO CASH
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov