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Form 497 - Yes on Measure E (2013-08-29)liq NAME OF FILER Committee For A Safer San Rafael - Yes On Measure E AREA CODE/PHONE NUMBER I.D. NUMBER (Wepplicable) 415-456-4000 1359556 STREET ADDRESS 1000 4th Street Suite 600 CITY STATE San Rafael CA n"I Amounts may be rounded to whole dollars. Date of 8/29/201 This Filing ----a Report No, 1-1 Amendment to Report No. ZIP CODE (explain below) 94901 No. of Pages MUTI 10T, . r., W 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 AMOUNT RECEIVED (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) IND San Rafael Firefighters P.A.C. com 9/25/13 ID# 891308 OTH $5, 000 P.O. Box 2519 PTY San Rafael, CA 94912 SCC ® Check if Loan IND 8/26/13 Stephen Mizroch, M.D. com Retired 71 Bryn Mawr Dr. CATH Physician $500 San Rafael, CA 94901 PTY SCC M Check if Loan FK� IND 9/25/13 Stephen Mizroch, M.D. com Retired 71 Bryn Mawr Dr. OTIC Physician $500 San Rafael, CA 94901 PTY I SCC Check if Loan kContributor Codes IND — Individual PTY — Political Party COM — Recipient Committee (other than PTY or SCC) SCC — Small Contributor Committef OTH — Other Reason for Amendment: FPPC Form 497 (Jan103) FPPC Toll -Free Helpline: `s• .• 866/275-3772