HomeMy WebLinkAboutForm 410 - Marc Levine for City Council 2013 TerminationStatement of Organization
Recipient Committee
Statement Type [] initial
Not yet qualified El or
Date qualified as committee
1. Committee Information
NAME OF COMMIT I EE
Marc Levine for City Council 2013
STREET ADDRESS (NO PO. BOX)
Type or print in ink
F Amendment
List 1.D. nurnber:
Date qualified as committee
(Ifapphcabfe)
9 Termination — See Part 5
List I.D. number:
4 1318388
12 / 12 1 12
Date of Termination
CITY STATE ZIP CODE AREA CODEIPHONE
San Rafael CA 94901
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX! E-MAILADDRESS
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
I THAN COUNTY OF DOMICILE
Marin
Attach additional udoavatiola on app )roptiateiy labeled uontvwation sheets
Date Stomp
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Bruce Raful
STREET ADDRESS (NO P.O, BOX)
STATEMENT OF ORGANIZATION
For Official Use Only
CITY STATE ZIP CODE AREA CODE/PHONE
San Anselmo CA 94901
NAME OF ASSISTANT TREASURER. IF ANY
S1 PEET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF PRINCIPAL CFFICER(S)
STREET ADDRESS (NO PO. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true �nd co plete. I certify Linder penalty of
perjury under the laws of the State of California that the foregoing is true and correct.
Executed on 12/12YI12
By
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ExeCUfed on By
FPPC Form 410 (Aprit,'2011)
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
STATEMENT OF ORGANIZATION
COMMITTEE NAME I.D. NUMBER
Marc Levine for City Council 2013 1318388
4. Type of Committee Complete the applicable sections.
• List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and
district number, if any, and the year of the election.
• List the political party with which each officeholder or candidate is affiliated or check "non-partisan."
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR FIELD
NAME OF CANDIDXI E/0FFICEHOLDER/S TATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECT ION PARTY
Marc Levine
San Rafael City Council Member
2009
El Non -Partisan
Democrat
El Non -Partisan
, List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCLALINSTITUTION AREA CODEIPHONE BANK ACCOUNT NUMBER
Union Bank 415-925-3390 49-502113 53
ADDRESS CITY STATE ZIP CODE
San Rafael CA 94901
# if-, Qg, I.- Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDAT=iS; NAVE OR MEASUREIS; FULL TITLE (INCLUDE BALLOT NO, OR LETTER; CANDIDAI'FtS) OFFICE SOUGHT OR HELD OR MEASURE ,S; jURiSDICTION
(INGLJDE DISTRICT NO. CITY OR COUNTY AS APPLICABLE) CrIF
Marc Levine
San Rafael City Council
a
FPPC Form 410 (April/2011)
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)