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Form 497 - Yes on Measure E (2013-11-05)Late Contribution Report NAME OF FILER Committee For A Safer San Rafael - Yes on Measure E AREA CODE/PHONE NUMBER T1. D. NUMBER (wapplicable) 415-456-4000 1 1359556 STREET ADDRESS 1000 4th Street Suite 600 CITY STATE San Rafael CA Late Contribution(s) Received DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBU RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) TOR 11/4/2013 The Permanente Medical Group c/o KP Financial Services Ops 75 N. Fair Oaks Ave. Pasadena, CA 91103 11/5/2013 San Rafael Firefighters PAC P.O. Box 2519 San Rafael, CA 94912 #891308 *Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH —Other Reason for Amendment: PTY — Political Party Small Contributor Committee W_= W �mqjvj�� IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) 0 H=wq1w AMOUNT RECEIVED $3,500.00 El Check if Loan $2,459.31 n Check if Loan FPPC Form 497 (Jan/03) FPPC Toll -Free Helpline: 866/ASK-FPPC 8661275-3772