HomeMy WebLinkAboutForm 497- Yes on Measure D (2016-05-20)497 Contribution Report Amounts may be rounded to whole dollars.
NAME OF FILER
Date of
a a
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
Committee to Support San Rafael Libraries - Yes on Measure D
This Filing 5/20/2016
6oClalOnly
D
•AREA
1,e
CODE/PHONE NUMBER
I.D. NUMBER (Wapplicable)
415-446-4222
1383895
Report No.
MAY 2 0 201
STREETADDRESS
❑ Amendment
i
1000 Fourth Street, Suite 600
Report No.
(exex plain below)
CITY CLERK'S 0
FICE
CITY
STATE ZIP CODE
❑ IND
San Rafael CA 94901
No. of Pages 1
1. Contribution(s) Received
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I D NUMBER)
CONTRIBUTOR
CODE '
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
AMOUNT
RECEIVED
5/20/2016
Gary O. Phillips
San Rafael, CA 94901
❑x IND
❑ COM
❑ OTH
Mayor
City of San Rafael
1,200
E] Check if Loan
❑ PTY
❑ SCC
i
Provide interest rale
❑ IND
❑ COM
❑ OTH
❑ Check if Loan
❑ PTY
❑ SCC
Provide interest rate
❑ IND
❑ COM
❑ OTH
❑ Check if Loan
❑ PTY
❑ SCC
i
Provide interest rate
Reason for Amendment:
"Contributor Codes
IND — Individual
COM — Recipient Committee (other than PTY or SCC)
OTH — Other (e.g.. business entity)
PTY — Political Party
SCC — Small Contributor Committee
FPPC Form 497 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov