HomeMy WebLinkAboutForm 465 - Police Association PAC (2013-10-19) BusheySupplemental Independen
Expenditure Report
(Government Code Section 84203.5)
SEE INSTRUCTIONS ON REVERSE I
Type or print in ink.
whole dollars.
[I Amendment (Explain Below)
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I.D. NUMBER (if recipient committee)
1. Commiftee/Filer Information 831553
MI EE/FILER'S NAME
San Rafael Police Association Political Action Committee
STREET ADDRESS (NO RO, BOX)
1520 Fifth Avenue
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA, 94901 (415) 485-3000
OPTIONALL FAX /E-MAIL ADDRESS
Report covers period
from 01/01/2013
through 10/19/2013
Date of election if applicable:
(Month, Day, Year)
11/05/2013
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Treasurer (if recipient committee)
NAME OF TREASURER
Ms. Beth Minka
MAILING ADDRESS
1520 Fifth Avenue
Page 1 of 2
For Official Use Only
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA, 94901 (415) 485-3000
OPTIONAL: FAX / E-MAIL ADDRESS
&I
2. NameOT Candidate or Measure Supported or Opposed CHECK ONE
NAME OF CANDIDATE OFFICE SOUGHT OR HELD AND DISTRICT, IF APPLICABLE SUPPORT OPPOSE
Maribeth Bushey -Lang City Council Member City of San Rafael, CA X
NAME OF BALLOT MEASURE BALLOT NO./LETT SUPPOR i OPPOSE
FPPC Form 465 (June/09)
FPPC Toll -Free Helpfine: 866/ASK-FPPC (8661275-3772)
Supplemental Independent Type
or print in ink.
ses
Expenditure s whole dollars.
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
San Rafael Police Association Political Action Committee
"`-♦• rN of
from 01/01/2013
through 10/19/013
Page 2 Of 2
I.D. NUMBER (If recipient com.)
•
•
4. Summary 41889.00
. Total independent expenditures of $100 or more made this period. (Part .) ...........................................................................................
. Total independent expenditures under made this period. of itemized.) ........................................................................................
. Total independent expenditures made this period(Add Lines .....................................................................................a...... 41889.00
5. Filing
Eater the name and address of each filing officer with whom the filer's most recent campaign statements (Form 450, 460 or 461) have been riled.
1) NAME OF FILING OFFICER
San Rafael City Clerk
ADDRESS (N. AND STREET)
1400 5th Avenue
CITY STATE ZIP CODE
San Rafael, CA 94901
NAME OF FILING OFFICER
ADDRESS . AND STREET)
CITY STATE ZIP CODE
6. m
Ification
) NAME OF FILING OFFICER
ADDRESS . AND STREET)
CITY STATE ZIP CODE
4) NAME OF FILING OFFICER
ADDRESS ('NO. AND STREET)
CITE' STATE ZIP CODE
certify that the " independent expenditure(s)" disclosed in this statement were not "made at the behest of " the candidate or committee that benefitted from the expenditure(s)
as those terms are defined in Government Code Section 820131 and FPPC Regulation 18225.7. 1 bave used all reasonable diligence in preparing and reviewing this
FPPC Form 465 (June/09)