HomeMy WebLinkAboutForm 461- Friends of the SR Public Library (2016-06-30)Major Donor and
Independent Expenditure Committee
Campaign Statement
SEE INSTRUCTIONS ON REVERSE
1. Name and Address
Statement covers period
from 01/01/2016
through 06/30/2016
NAME OF FILER
FRIENDS OF THE SAN RAFAEL PUBLIC LIBRARY
SAN RAFAEL
(If filer is other than an individual)
PHYLLIS BRINCKERHOFF
CA 94901
AREA CODE/DAYTIME PHONE
. Nature and Interests of Filer (Complete each applicable section.)
A FILER WHO IS AN INDIVIDUAL MUST LIST THE NAME, ADDRESS, AND BUSINESS INTERESTS
OF EMPLOYER OR, IF SELF-EMPLOYED, THE NAME, ADDRESS, AND NATURE OF THE BUSINESS
NAME OF EMPLOYER/BUSINESS I BUSINESS INTERESTS
A FILER THAT IS A BUSINESS ENTITY MUST DESCRIBE THE BUSINESS ACTIVITY IN WHICH IT IS
ENGAGED
E] A FILER THAT IS AN ASSOCIATION MUST PROVIDE A SPECIFIC DESCRIPTION OF ITS INTERESTS
® A FILER THAT IS NOTAN INDIVIDUAL, BUSINESS ENTITY, OR ASSOCIATION MUST DESCRIBE THE
COMMON ECONOMIC INTEREST OF THE GROUP OR ENTITY
ASSIST THE SAN RAFAEL PUBLIC LIBRARY IN SERVING THE ENTIRE
❑ Amendment (Explain): COMMUNITY
0
MAY 2 0 2016
Date of election if applicable:
(Month, Day, Year) age 1 of 2
06/07/2016
CITY CLERK'S OF ICE F rOfficial use only
3. Summary
(Amounts may be rounded to whole dollars.)
1. Expenditures and contributions
(including loans) of $100 or more
15,000.00
made this period. (Part 5.) ................................................ $
2. Unitemized expenditures and
contributions (including loans) under
$100 made this period ...................................................... $
3. Total expenditures and contributions 15,000.00
made this period. (Add Lines 1 + 2.)................SUBTOTAL $
4. Total expenditures and contributions
made from prior statement. (Enter
amount from Line 5 of last statement
filed. If this is the first statement for
the calendar year, enter zero.) ......................................... $
5. Total expenditures and contributions
(including loans) made since
January 1 of the current calendar year. 15,000.00
(Add Lines 3 +4.)...................................................TOTAL $
4. Verification
I have used all reasonable diligence in preparing this statement. I have
reviewed the 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
05/20/2016
DATE
B
Y
SIGNATU OF INDIVIDUAL DONOR OR
RESPONSIBLE OFFTCER. IF OTHER THAN AN INDIVIDUAL
FPPC Forth 461 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Major Donor and
Independent Expenditure Committee Amounts may of rounded
p p to whole dollars.
Campaign Statement
SEE INSTRUCTIONS ON REVERSE
FRIENDS OF THE SAN RAFAEL PUBLIC LIBRARY
Statement covers period
from 01/01/2016
through 06/30/2016
5. Contributions (Including Loans, Forgiveness of Loans, and Loan Guarantees) and Expenditures Made
(if more space is needed, use additional copies of this page for continuation sheets.)
2
Page—....__.. of
FPPC Forth 461 (Jan/2016)
FPPCAdvice: advicea@fppc.ca.gov (866/276-3772)
www.fppc.ca.gov
DESCRIPTION OF
CANDIDATE AND OFFICE,
CUMULATIVE AMOUNT
DATE
NAME, STREET ADDRESS, CITY, STATE AND ZIP CODE
TYPE OF PAYMENT
PAYMENT
MEASURE AND JURISDICTION,
AMOUNTTHIS
RELATED TO THIS
OF PAYEE
(IF OTHER THAN MONETARY
OR COMMITTEE
PERIOD
CANDIDATE, MEASURE,
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONTRIBUTION OR LOAN)
OR COMMITTEE
COMMITTEE TO SUPPORT SAN RAFAEL
® Monetary
MEASURE D
LIBRARIES
Contribution
1000 FOURTH STREET, SUITE 600
❑ Loan
15,000.00
15,000.00
3/23/2016
SAN RAFAEL, CA 94901
❑ Non -Monetary
Contribution
FPPC I.D. NUMBER: 1383895
❑ Independent
Expenditure
® Support ❑ Oppose
❑ Monetary
Contribution
❑ Loan
❑ Non -Monetary
Contribution
❑ Independent
Expenditure
❑ Support ❑ Oppose
❑ Monetary
Contribution
❑ Loan
❑ Non -Monetary
Contribution
❑ Independent
Expenditure
❑ Support ❑ Oppose
❑ Monetary
Contribution
❑ Loan
❑ Non -Monetary
Contribution
❑ Independent
Expenditure
❑ Support ❑ Oppose
SUBTOTAL $ 15,000.00
FPPC Forth 461 (Jan/2016)
FPPCAdvice: advicea@fppc.ca.gov (866/276-3772)
www.fppc.ca.gov