HomeMy WebLinkAboutForm 460 - Police Association PAC (2016-12-31)Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216 .5)
SEE INSTRUCTIONS ON REVERSE
S ta teme nt covers peri od
from 09/25/2016
throug h _..:1;.::2:.!../.::.3.::.1:.../2:;,;0:.,;1:.,;6:...-__ _
1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4.
o Officeholder, Candidale Controlled Committee o State Candida Ie Election Committee o Recall
(Also CompJelB Pari 5)
I]J General Purpose Committee
® Sponsored o Small Contributor Committee o Political Party/Central Committee
3. Committee Information
o Primarily Formed Ballot Measure
Committee o Controlled o Sponsored
(Also CompJol<> Pa116)
o Primarily Formed Candidatel
Officeholder Committee
(Al$o ~B Perl 7)
1.0 . NUMBER
831553
COMMlnEE NAME (OR CANOIOATE·S NAME IF NO COMMITIEE)
San Rafael Police Association Political Action Comm~ttee
STREET ADDRESS (NO P.O. SOX)
1520 Fifth Avenue
CITY STATE ZIP CODE
San Rafael CA 94901
MAILING ADORESS (IF DIFFERENT) NO. AND STREET OR P.O BOX
P .O . Box 151557
CITY STATE ZIP CODE
San Rafael CA 94915 -1557
OPTIONAL: FAX / E·MAlL AODRESS
4 . Verification
AREA COOE/PHONE
(415)485-)000
AREA CODE/PHONE
Date o f election if appl
(Month. Day, Year)
JAN 2 0 2017
2. Type of Statement:
o Preelection Statement
00 Semi-annual Statement
o Termination Statement
(Also file a Form 410 Termination)
o Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
MS. Bel:h Minka
MAILING AOORESS
1520 F1fth Avenue
CITY STATE
San Rafael CA
NAME OF ASSISTANT TREASURER. IF ANY
Ms. Stacy E. Owens
MAILING AOORESS
5940 College Avenue
CITY
Oakland
OPTIONAL: FAX I E-MAIL ADDRESS
STATE
CA
of 112
o Quarterly Slatement
o Special Odd-Year Report o Supplemental Preelection
Statement -Attach Form 495
ZIP CODE
94 901
Z IP CODe
94618
AREA CODE/PHONE
(415)485 -3000
AREA CODE/PHONE
(510)652-1000
I have used aI/ reasonable diligence in preparing and reviewing this statement ond to the best of my knowl
under penalty of pe~ury under the laws of the State of California thaI the foregoing is true and correct .
d herein and in the attached schedules is true end complete . I certify
Executed on 01/17 /20 17
Date
Executed on 01/17/2017
Date
Exeruled on
Dote
Executed on o.ne
By ____________ ~~~~~~~~~~~~~~~~~~------------S4gn<tluJe 01 ConlJoi ing Ofl\ceholCIN. Candidate. Slate Measur" Proponenl
By------------~~~~~~w=~~~~~~~~~~~-----------S4gnalurt'01 CoObtliing Offoccl1c1~"'. Caildidate. Sial" Measure Pro ponent
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca .gov (866/275-3772) ._-_ . "'"--- --.. -
Recipient Committee
Campaign Statement
Cover Page -Part 2
5, Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENTIALIBUSINESS ADDRESS (NO . AND STREET) CITY STATE ZIP
Related Committees Not Included in this Statement: Lin any committees
not included in this stlltement /hat are controlled by you or are primarily formed to racelve
contributions or make eJtpenditures on behllif 01 your candidacy.
COMMITIEE NAME 1.0. NUMBER
NAME OF TREASURER CONTROLLED COMMITIEE?
DYES 0 NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O . BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMIlTEE NAME 1.0 . NUM BER
NAME OF TREASURER CONTROLLED COMMmEE?
DYES O NO
COMMITIEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COVER PAGE -PART 2
-~
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
BAlLOT NO. OR LETTER JURISDICTION o SUPPO RT o OPPOSE
Identify the controlling officeholder, candidate, or state measure proponent, jf any.
NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT
OFFICE SOUGHT OR HELD I DISTRICT NO . IF AN'
7. Primarily Formed Candidate/Officeholder Committee List names o(
officeholder(s) or c:mdidate(s) lor which this committee Is prImarily form~.
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE
NAME OF OFFICEHOLDER OR CAN DIDAT E O FFICE SOUGHT OR HELD o SUPPORT o OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE
Attach continuation sheets If necessary
FPPC Fo"" 460 (Jan/2016)
FPPC Advice : advice@fppc.ca,gov (866/275-3772) ______ c o. ___ _
SUMMARY PAGE Campaign Disclosure Statement
Summary Page
Amounts may be rounded
to whole dollars.
Statement covers period CALIFORNIA 460
FORM
seE INSTRUCTIONS ON REVERSE
NAME OF FILER
San Rafael Police ASsociation Political Action committee
ColumnA
TOTAL 111 IS J>£RIOO Contributions Received
(FROM AnACt1EDSCHEOULES)
1. Monetary Contributions ............ ...................... ......... Schedule A. Lme 3 S 8,429.20
2. Loans Received ...................................................... Schedule B. Une 3 0 .00
3. SUBTOTAL CASH CONTRI BUTIONS ....... ............. ..... Add Lines 1 + 2 $ 8,429 .20
4. Nonmonetary Contributions . ......... .......................... Schedule C. Line 3 50 .00
5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3" ., S 8,479 .2 0
Expenditures Made
6. Payments Made....................................................... Schedule E, Lme 4 $ 1,132.38
7 . Loans Made ............................................................. Schedule H. Line 3 0 .00
8. SUBTOTAL CASH PAYMENTS .............................. Add Lines 6 + 7 S 1,132 .38
9. Accrued Expenses (Unpaid Bills) ............................... Schedule F. Line 3 ____________ o~.oo
10. Nonmonetary Adjustment .......................................... Schedule C. Line 3 50 .00
11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 .. 9 + 10 $ 1,182.38
Current Cash Statement
12. Beginning Cash Balance ....................... Previous Summary Page. Line 16 $ 49,939.71
13. Cash Receipts ................................................... Column A. Line 3 above 8,429 .20
14. Miscellaneous Increases to Cash ........................... Schedule I. Line 4 2 .10
1 5. Cash Payments.. ..................... ........................... Column A. Line 8 above 1,1.32.38
16. ENDING CASH BALANCE .......... Add Lines 12" 13" 14, then subtract Line 15 $ 57,238 .6)
If this is a termina/ion statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED ........................... Schedule B. Par12 $ 0.00
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ............................ ,,,......... See Instructions on reverse $ 0 .00
19 . Outstanding Debts ......................... AddLine2+Line9lnColumnBabove $ 0.00
from 09/25/2016
th ro ug h _--=1:..:2~/.::.3.::.1!..../ =-2 0::,;1:.,:6::....-__ Page __ ) _ .. _ of 112
ColumnB
CALENDAR YEAR
TOTAL. TO CATE
S 27,720.01
0.00
$ 27,720.01
50.00
S 27,770.01
$ 7,209.59
0 .00
S 7,209 .59
0 .00
50.00
$ ______ 7.:..,~259 . 59
To calculate Column B, add
amounts in Column A 10 the
corresponding amounts
from Column B of your last
report. Some amounts in
Column A may be negative
figures that should be
subtracted from previous
period amounts . If this is
Ihe firsl report being filed
for Ihis calendar year, only
carry over the amounls
from Lines 2, 7 . and 9 (if
any).
1.0. NUMBER
831553
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
111 through 8130 711 to Date
20. Contributions
Received $ S
21. Expenditures
Made $ $
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made"
II' SUbJoct to Va lunlary Expenditure Llmil)
Date of Election
(mm/ddlyy)
----~----~/-----
Total to Date
$------
$------
"Amounts in this section may be different from amounts
reported in Column B.
FPPC Form 460 (JanJ2D16)
FPPC AdvIce: ildvice@fppc.ca.gov (866/275-3772)
Schedule A
Monetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
San Ra.fael Police Association Political Action Committee
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR DATE
RECEIVED (IF COMMITTEE. ALSO ENTER 1.0 NUMBER)
·09/30/2016 Elisha Aciams
c/o: San Rafael Police Associatlon 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
~ntermediary: San Rafael Police Association,
10/20/2016 Elisba Adams
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
union member's dues received through
inte~diary: San Rafael Police Association,
11/05/2016 Elisha Adams
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
union member's dues received through
int:erm~diary: San Rafael Police Association,
" 11/15/2016 Elisha Adams
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fift:h Avenue San Rafael CA 94901
11 30 2016 Bllsha Adams
C/o: San Rafael Police ASsociation 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
interm~diary: San Rafael Police Association,
~
Schedule A Summary
1, Amount received this period -itemized monetary contributions.
Amounts may be rounded
to whole dollars.
IF AN INDIVIDUAL, ENTER CONTRIBUTOR OCCUPATION AND EMPLOYER CODE .. (IF SELF·EM~lOVEO. ENTER NAME
OF eusINESS)
01ND Officer
DeOM City of San Rafael
DOTH
OPTY
osee
@IND Officer
DCOM City of San Rafael
DOTH
OPTY
osee
01ND Officer
DeOM City of San Rafael
DOTH
OPTY
DSCC
OOIND Officer
oeOM City of San Rafael
DOTH
OPTY
osce
01ND OffJ.cer
City of San Rafael DeOM
[lOTH
DPTY
OSCC
SUBTOTAL $
SCHEDULE A
Statement covers period
CALIFORNIA 460
FORM from 09/25/2016
through 12/31/2016
LD. NUMBER
B31553
AMOUNT CUMULATIVE TO DATE PER ELECTION
RECEIVED THIS
PERIOD
16.30
16.30
16.30
16.30
16,)0
81.50 1
CALENDAR YEAR TO DATE
(JAN 1 -DEC. 31) (IF REQUIRED)
376.21
376.21
376.21
376.21
376.21
'Contrlbutor Codes
IND-Individual
(Include all Schedule A subtotals.) ,., ............................ , ..... " .. , .... ,." .... , ...... ,', .... "., .... ,""., ... ,., ............... $ ___ ----'8"---'-,--"-0.:...:.75::....:.~1_"__.0 COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party 2, Amount received this period -unitemized monetary contributions of less than $100 ... ,., ..... , ..... , .... " ..... $ _____ .:;3.:;5.:..4.:...1:..;0:.-
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...... " .... ".", ..... TOTAL $ ~~ __ ..;;8":"..;.4 ~2 ;;.9 ;..;. 2=0
SCC -Small Contributor Committee
FPPC Form 460 (Janl2016)
FPpe Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael ~olice Association Political Action committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPLOYED. ENTER NAME
OF BUSINESSI
QFCOM~lnEE..ALSOENITRIQ WU"l8EJ'l1 CODE *
12 15/2016 Elisha Adams
c/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael. CA 94901
Union memb e r's dues received th~ough
intermediary: San Rafael Po~ice Association.
1520 Fifth Aven u e San Rafael CA 94901
12/29/20lb Elisha Adams
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Ra(ael, CA 94901
Unic~ member's dues received through
intermediary: San Rafael Pol~ce Association,
09/30/2016
1
·Contributor Codes
IND -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g .. business entity)
PTY -Political Party
see -Small Contributor Committee
FiLth
Fitch
Fifth
[RJIND
DCOM
DOTH
OPTY
Dsec
IR]IND
DeOM
DOTH
DPTY
osee
lKJlND
DeoM
DOTH
oPTY
oscc
lKJlND
oeOM
DOTH
oPTY
osee
[R]IND
DCOM
DOTH
DPTY
osee
Officer
City of San Rafael
officer
City of San Rafael
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Isergeant
ICity of San Rafael
SUBTOTALS
Statement covers period
~om 09/25/2016
th rough _....;1:..;2:..:/....:3;,.:1:..:;/..,;:2;,.:0.,::1;,.:6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page _--=-5 _ of 112
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULAnvE TO DATE
CALENDAR YEAR
(JAN. 1 • DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.2l
16.30 376.21
16.30 376.20 1
I
16.30 376.20
16.30 376.20
B1. 50 I
FPPC Form 460 (JanJ2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
~~---- - - --, ,
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael ?olice Associacion Policical Action Comm i ttee
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IFCOIolMITIEE.ALSOENTER 1.0 NUMBER) CODE *
11 15/2016 Raul Aguilar OOIND
C/o : San Rafael Police Associacion 1520 Fifth DCOM
Avenue
San Rafael. CA 94901 DOTH
Union member' s dues received throuoh 0 PTY
intermediary: San Rafael Police Association, 0 SCC
1520 F~f th Avenue San Rafael CA 94901
11 /30/2016 Raul Agu i l a r IRJIND
C/o : San Rafael Police Association 1520 Fifch DCOM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received througb 0 PTY
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SElI'-EMPlOVEO. eNlCR NAME
OF BUSINESS)
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Statement covers period
from 09/25/2016
th rough __ 1-,-2:;":/,-,3:..:1"",/..,;:2:..:0,,,1;,,:6 __ _
SCHEDULEA (CONT.)
CALIFORNIA 460
FORM
Page _--=-6 _ of 112
1.0. NUMBER
B31553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 -DEC . 31)
PER ELECTlON
TO DATE
(IF REQUIRED)
16 .30 376.20
16.30 376.20
intermediary, San Rafael Police Association, LISCC
--~~~--4~-~'~~~llW~~~~~~~~~~L-----~---------4----------------------+-------------~--------------~----------------12/15/2016 Raul Aguilar IXlIND Sergeant 16" .)0 376.20
C/o: San Rafael Police Association 1520 Fifch oCOM City of San R.afael
Avenue
San Rafael, CA 94901 DOTH
Union member' s dues received through 0 PTY
iDcermediary: San Rafael Police Association, 0 sec
1 enue San Rafael CA 4 1
12/29/2016 Raul Aguilar ~IND-----r.s~e-r-g-e-a-n7t-----------------r----------1~6~.3~0~----------~3~776-.~20~--------
C/o : San Rafael Police Association 1520 Fi fth OX COM City of San Rafael
Avenue
San Rafael, CA 94901 OOTrl
Onion membe!:' s dues received through 0 PTY
intermediary: San Rafael Police Associat~on , OSCC
1520 Fifth Avenue, San Rafael. CA 94901
Ant any Augustyn OOIND
C/o : San Rafael Police Association 1520 Fifth OX COM
Avenue
San Rafael, CA 94901 DOTH
Onion member's dues received through 0 PTY
interm7diary: San Rafael police Association, OSCC
'Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g .. business entity)
PTY -Political Party
SCC -Small Contributor Committee
o u::er
Cicy of San Rafael
SUBTOTAL $
16 .30 376.20
81 .50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ciI.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Association Political Action Committee
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(if CCMMITII:E. ALSO I:NTER 10. NUMBER) CODE *
10/20/20iG'-Anthony Augustyn OOINO
C/o; San Rafael Police Association 1520 ~·:'fth oeOM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received through [JPTY
intermediary: San Rafael ?olice Association, OSCC
1520 Fifth Avenue San Rafael CA 94901
11/05/2016 Anthony Augustyn IKIIND
C/o: San Rafael Police Association 1520 Fifth DeOM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues recelved through oPTY
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
IIF SELi<-EMPlOYED. ENTER NA...,e
OF BIJ5INESS)
Officer
City of San Rafael
Officer
City of San Rafael
Statement covers period
from 09/25/2016
llirough __ ~1~2~/~3~1~/~2~0~1~6 ____ ___
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page __ 7",--_ of 112
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16 .30 376.20
16 .30 376 .20
intermediary: San Rafael Police Association, OSCC
.: ael , ~~~~~------~--------~~~--------------------4---------------+-----------------~----------------IK)INO O~:icer 16 .30 376.20 11/15/2016
Fifth
1l/30/2016
Fifth
Avenue
San Rafael, CA 94901
Union member's duee received through
intermediary: San Rafael Police ASsociation,
1520 Fifth Avenue, San Rafael , CA 94901
t:. or.y Augustyn
C/o : San Rafael Pol~ce ASSOclation 1520 Fifth
Avenue
San Rafael, CA 94901
Union membe.'s dues received through
intermedia~: San Rafael Police Association,
'Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or seC)
OTH -Other (e.g .. business entity)
PTY -Political Party
sce -Small Contributor Committee
oCOM City of San Rafael
DOTH
oPTY
DSCC
IRIIND
DeOM
DOTH
o PTY
o see
IKIIND
DeOM
DOTH
DPTY
[JSCC
Officer
City of Sar. Rafael
leer
City of San Rafael
SUBTOTAL $
16.30 376.20
16.30 376.20
91. SO I
FPPC Form 460 (JanJ2016)
FPPC Advice: advice@fppc.ca.gov (866/275..3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Association Political Accion Committee
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IFCo~Mrrree.ALSOENTERI _D NUMBeR) CODE ..
12/29/2016 Ant:hony AUguSLyn IK)IND
C/o: San Rafael Police Association 1520 Fifth
Avenue oCOM
San Rafilel, CA 94901 DOTH
Union member's dues received through 0 PTY
IF AN INDIVIOUAL. ENTER
OCCUPAnON AND EMPLOYER
(IF SELF-EUPL-OVEO, ENTER NAME
OF eUSINESSI
Officer
City of San Rafael
Sl<!tement covers period
from 09/25/2016
~rough __ ~1=2~/~3~1/~2~O~1=6 ____ __
SCHEDULE A (CONT.)
CALIFORNIA 460'
FORM
Page 8 of 112
1.0 NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
fODATE
(IF REQUIRED)
16.30 376.20
intermediary: San Rafael Police ASsociation, OSCC
1520 Fifth Avenue San~R~a~f~a~e~l~~C~A~~9~4~9~0~1 ______ -r~~ ______ ~~ ____ ~ ______________ ~ __________ ~~~--__ ------~~~~------------------
09/30/2016 James Bellamy --IEJIND Corporal 16.30 376 .20
C/o: San Rafael ?olice Association 1520 Fifth DeOM City of San Rafael
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received through [JPTY
intermediary: Sao Rafael Police Association , (JSCC , .
10/20/2016
Fifth
11./05/2016
Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue, San Rafael , CA ~490l
11 15 2016 James Be amy
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Ratael Police Association,
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other than P1Y or seC)
OTH -Other (e_g., business entity)
PTY -Political Party
sce -Small Contributor Committee
IK)IND
(JCOM
DOTH
OPTY
OSCC
[xJIND
DCOM
DOTH
OPTY
osee
~IND
oeOM
DOTH
DPTY
OSCC
Corporal
City of San Rafael
Corporal
City of San Rafael
Corpora
City of San Rafael
SUBTOTALS
376.20
16' _ 30 376,20
1 .30 376.20
81.50 1
FPPC Form 460 (JanJ2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Commit~ee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPLOYED, ENTER NAME
OF BUSINESS)
~FCOMMIITFf ,ALSOENTeRI D NUIoABER) CODe *
11 30/2016 James nellamy
C/o: San Rafael Police ASSociation 1520 Fif~h
Avenue
San Rafael, CA 94901
Union member'S dues received through
in~ermedia~: San Rafael Police Association,
1520 Fif~h Avenue San Rafael CA 94901
12/15/2016 James Bellamy
C/o: San Rafael police Aeeociation 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
12/29/2016 James Bellamy
C/o: San Rafael Police Association 1520 FiEch
Avenue
San Rafael, CA 94901
Union member's dues received through
intermedia~: San Rafael Police ASsociation,
1 20 Fifch Av nue an Rafa 1 4 01
09/30/2016 Kelly Benitez
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received chrough
intermediary: San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
Ke y Benltez
c/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
'Contributor Codes
INO -Individual
, San Rafael CA 9490 1
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g .• business entity)
PTY -Political Party
SCC -Small Contributor Committee
IRJINO
DCOM
DOTH
DPTY
Dsee
~IND
DCOM
DOTH
OPTY
osee
[i]IND
OCOM
DOTH
oPTY
OSCC
\XJfNO
nCOM
DOTH
oPTY
osee
IRJIND
oeoM
DOTH
oPTY
oscc
Corporal
City of San Rafael
Corporal
City of San Rafael
Corporal
Cicy of San Rafael
police Off icer
City Of San Rafael
SUBTOTAL $
Statement covers period
rrom 09/25/2016
through _-,1::..:2:;.:/-,3:...:1:..:/-,2:...:0:...:1:...:6-,-__
SCHEOULEA (CaNT.)
CALIFORNIA 460
FORM
Page __ 9~_ of 112
1.0. NUMBER
BlISS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 • DEC . 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16,30 376.20
16 ,)0 )76.20
16.30 376.20
16.30 269.10
16.30 269.10
81.50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.C3.gov (8661275-3772)
.. _. _ c ." _____ ..
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECENED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED. EN~ NAMe
OF BuSINESSI
IIFCOMMlneE ALSO ENrER 1.0 NUM~) CODE *
11/05/2016 Kelly Benitez
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
11/15/2016 Kelly Benitez
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
Fifth
12/15/2016
Fifth
Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
interm7dia ry: San Rafael Police Associa~ion,
'Contributor Codes
IND -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g, business entity)
P1Y -Political Party
sec -Small ContnbutorCommittee
lKJlND
oeOM
DOTH
OP1Y
osec
!!lIND
oeOM
DOTH
oP1Y
osec
!XlIND
oCOM
DOTH
OPTY
osee
!!lIND
nCOM
DOTH
oP1Y
osee
!!lIND
oCOM
DOTH
UP1Y
osee
Police Officer
City Of San Rafael
Police Of ficer
City Of San Rafael
Poli ce Of f icer
City Of San Rafael
Police Offi.cer
City Of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
~rough __ ~1~2~/~3~1/~2~0~1~6 ____ __
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page __ -=10,,--of 112
I.D.NUMBER
a31553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVETO DATE
CALENDAR YEAR
(JAN. 1 -DEC . 31)
PERELEcnON
TO DATE
(IF REQUIRED)
16 .10 269_10
16 ,30 269.10
16.30 269.10
16.30 269 .10
16_30 269.10
81. 50 I
FPPC Form 460 (Jan'2016)
FPpe Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
~F SElF-(;MP~OYEO. ENTER NAME
OF BUSINESS)
(IFCOI..4MlnEE. ALSOENTER 1.0 NUMSERI CODE ...
09/30 2016 Todd Berringer
C/o: San Rafael Police Association 1520 Fifth
Avenue
San ~fael, CA 94901
Union member'S dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94 9 01
10/20/2016 Todd Berringer
C/o: San Rafael Police ASeociation 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
interm7diary: San Rafael Police Association,
11/05/2016
11/15/2016
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
Fifth
Fifth
Fifth
IK]INO
oeOM
[jOTH
OPTY
OSCC
IKIIND
DeOM
UOTH
OPTY
osee
~IND
DCOM
DOTH
npTY
Dsec
IKlIND
DCOM
DOTH
OPTY
nsec
IKlIND
DeOM
nOTH
DPTY
OSCC
Sergeant
City of San Rafael
Sergeant
C~ty of San Rafael
Sergeant
City of San Rafael
Sergeant
Ci~y of San Rafael
Sergeant
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
throug h __ 1_2-,/_3_1..:./_2_0_1_6 __ _
SCHEDULEA (CONT.)
CALIFORNIA 460
FORM
Page 11 of 112
I D.NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN, 1 • DEC, 31)
PER ELEC1l0N
TO DATE
(IF REQUIRED)
16.30 :>76 _ 20
16_30 376.20
376.20
16,30 376.20
16.30 376.20
81.S01
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Associ ation Poli~ical Action Committee
DATE
RECEIVED
FULL NAME , STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IFCQ.'-!IJ.JTTEE .ALSOENlERIP.NUMBERI CODE *
12/:2 9 / 2 0 16 Todd Berringer IRJINO
C/o : San Rafael Pol ice Association 1520 Fifth 0 COM
Avenue
San Rafael, CA 94901 OaTH
union member's dues received through 0 PTY
interm7diary : San Rafael Pol~ce Associa~ion, O SCC
09/30/2016 Lynne Bracken lXJlND
C/o : San Rafael Police Association 1520 Fifth DCOM
Avenue
San Rafael , CA 94901 DOTH
union member 's dues received through 0 PTY
intermediary: San Rafael Police Association, 0 SCC
l~?-F ' 1
--=-10-=--/ 2~0~/-;-:2::-:0:-::1~6;--t-:Lynne Bracken ~ IND
C/o : San Rafael Police Association 1520 Fifth X
Avenue DCOM
San Rafael, CA 91901 DOTH
Union member ' s dues received through 0 PTY
intermediary : San Rafael Police Association, OSCC
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SElF.EIoAPl.OYEO. ENTER NAME
OF BUSINESS)
Sergean t
City of San Rafael
Records Clerk
Ci ty of San Rafael
Records Clerk
City of San Rafael
Statement covers period
from 09/25/2016
through 12/31/ . ...:2:c,:0:..;:1:.,:6 __ _
AMOUNT
RECENED THIS
PERIOD
16.30
12 .70
12.70
SCHEDULE A (CaNT.)
CAL.IFORNIA 460
FORM
Page 12 of 112
1.0 NUMBER
831553
376.20
294 .30
294.30
PERELEcnON
TO DATE
(IF REQUIRED)
1520 Fifth Avenue, San Rafael, CA 94901 ~~~~~~~L~ynn~~e~B~r~a~c~e~n~~~~~~~~~~~~~-------r--~---D----~~R~e~c~o~r~s~~~-----------1----------~1~2~.~7~0~----------2~9·4-.·3~O4------------------
C/o; San Rafael Police Association 1520 Fifth xlN City of
Avenue oCOM
San Rafael, CA 94901 DOTH
Union member' s dues received through 0 PTY
intermediary : San Rafael Police Association, OSCC
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g ., business entity)
PTY -Political Party
SCC -Small Contributor Committee
SUBTOTAL $
FPPC Form 460 (Jan/20161
FPPC Advice: advice@fppc.ca .gov (866/27S -3n2)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Po1ice Associ a t i on Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME , STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(I~COMMmEE.ALSOEIm:RI 0 NUMBeR) CODE *
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF S€LF-EMPLOYED. ENTER NAME
OF BUSINESS)
11/15/2016
11/30/20~6
Lynne Bracken
C/o, San Rafael ~olice Association 1520 Pifth
Avenue
San Rafael , CA 94901
Union member's dues received through
intermediary, San Rafael Police Association,
1520 Fifth Avenue San Rafa 1 CA 94901
Lynne Bracken
c/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
12/15/2016 Lynne Bracken
c/o: San Rafael Police Association 1520 Fifth
A.venue
San Rafael, CA 94901
Union member's dues receIved through
intermediary : San Rafael ~olice AssociatIon,
152 0 Fifth Avenu San Rafael 4 01
12/29/201E Lynne Bracken
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Associat~on,
1520 Fifth Avenue, San Rafael, CA 94901
09 30 2016 Antonette Bu oc
C/o: San Rafael ~olice Association 1520 Fifth
Avenue
San Rafael , CA 94901
Union member's dues rece~ved through
intermedi ary : San Rafael Police II.ssociation,
'Contributor Codes
IND -Individua l
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e .g ., business entity)
PTY -Political Party
SCC -Small Contributor Committee
!&lIND
OCOM
DOTH
oP"N
osee
IKIIND
DCOM
DOTH
OPTY
osee
IXJIND
DeOM
DOTH
OPTY
osee
!XlfND
DCOM
DOTH
DP"N
osee
IK]IND
DCOM
DOTH
OP"N
OSCC
Records Clerk
City of San Rafael
Records Clerk
City of San Rafael
Records Clerk
City o~ San Rafael
Records Clerk
City of San Rafael
CommunI t y Se rvIce 0 lcer
City of San Rafael
SUBTOTAL $
Statement cOllers period
from 09/25/2016
through _....:1:.;:2:.-'./..:;3.::;1",-/;::.2 0.:..;1::..6~.
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page 13 of 112
1.0 NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12.70 294.30
12.70 294,30
12 .70 294 _30
12.70 291 ,30
12,70 294.30
63 .50 1
FPPC Form 460 (JanJ2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
SCHEDULEA (CONT) Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
Statement covers period
CALIFORNIA 460
FORM
NAME OF FILER
San Rafael Police Associa~ion Political Action Committee
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IFCQMUITTEE.ALSOEtm:RID.NUMB:R) CODE *
from 09/25/2016
~rough __ ~1~2~/~3~1~/~2~0~1~6 ____ ___ Page 14 of 112
1.0 NUMBER
831553
IF AN INONIDUAL, ENTER AMOUNT CUMULATIVE TO DATE
OCCUPAll0N AND EMPLOYER RECEIVED THIS CALENDAR YEAR
(!FSELF.EMPLOYED.ENTERNAME PERIOD (JAN. 1 -DEC. 31)
OF EWSINESS)
PER ELECTION
TO DATE
(IF REQUIRED)
-1~0~7T.2~O~/~2~0~176-'-An--to-n-e-t~~e~e-u'l'lO~C~k~---------------------------;--~=X~I-N-O-----+c~o~n-w~un~i~t-y~S~e~rv~i~c~e-O~f7f71"c~e~r~--------~1~2~.~7~0~----------=2=94~.3~O~------------------
C/o: San Rafael Police Association 1520 Fifth City of San Rafael
11/05/2016
1.!./lS/2C16
'li/J0/2016
12/lS/20iE
Avenue oCOM
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
intermediary: San Rafael Police Association, osce
1520 FiEth Avenue San Rafael CA 94901
Antonette Bullock [IDINO
C/o: San Rafael Police Association 1520 Fifth oeOM
Avenue
San Rafael. CA 94901 DOTH
Union member's dues received through DPTY
interm7diary; San Rafael Police Association, []seC
AntonettI! 8ullock ~IND
C/o ; San Rafael Pol ice Association 1520 Fifth oeOM
Avenue
San Rafael, CA 94901 DOTH
union member' e clues received through 0 PTY
intermediary : San Rafael Police Association, osee
I? Fi va an Rafael ell. 4 01
Antonette Bullock ~
C/o: San Rafael Police Association 1520 Fif~h X INO
Avenue nCOM
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
intermediary: San Rafael Police II.ssociation, OSCC
1520 Fifth Avenue, San Rafael, CA 94901
'Antonette Bu Oc
C/o: San Rafael Police Association 1520 Fifth [IDINO
Avenue oCOM
San Rafael, CA 91901 DOTH
Union member's dues received through 0 PTY
intermed~ary: San Rafael Police Association, osee
. 'I
'Contribulor Codes
IND -Individual
COM -Recipient Committee
(other than PlY or SCC)
OTH -Other (e .g., business entity)
PrY' -Political Party
SCC -Small Contributor Committee
Community Service Officer
City Ot San Rafael
Community Service Officer
City of San Rafael
Community Service Officer
City of San Rafael
Commun~ty Serv~ce 0 lcer
Clty of San Rafael
SUBTOTAL $
12 .70 294.30
12.70 294.30
12.70 29~.30
12.70 291.30
63.50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advh:e@fppc.ca.gov (866/275-3n2)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Associa~ion Policical Accion Commi~tee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND liP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(If SEL.F·EIAPLOYED. ENTER NAME
OF BUSINess)
IIFCO~l.\fTTEE.ALSOENTERI 0 NUMDER) CODE *
12 29 2016 Antonet te Bullock
C/o; San Rafael Police Association 1520 Fifth
Avenue
San Rafael, LA 94901
Union member's dues received through
in~ermediary: San Rafael Police Association,
~~~~~~~15~2~O Fifth Avenue San Rafael LA 94901
09/30/2016 Mich'~"el Byers
C/o: San Rafael Police Association 1520 FiEth
Avenue
San Rafael, LA 94901
Onion member's dues received through
intermediary: San Rafael PoIJ.ce Association, . ,
10/20/2016 Michael Byers
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received throU9h
intermediary: San Rafael Police Association,
1520 Fi Ave e San Rafae A 94 01
11/05/2016 Michael Byers
C/o : San Rafael ~olice Association 1520 Flfth
Avenue
San Rafael, CA 94901
Union member's dues rece~ved through
intermediary ; San Rafael Police Association,
1520 fifth Avenue San Rafael, CA 94901
MJ.c ae ayers
C/o : san Rafael police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Onion member's dues received through
incermediary: San Rafael Police Association,
152 Q FiJ'th Ayenlle..........S.an Rafael CA 94..'llU
·Con\libutor Codes
IND -Individual
COM -Rec:ipient Commitlee
(other than PTY or SCC)
OTH -Other (e.g ., business entity)
PTY -Political Party
SCC -Small Contnbutor Commitlee
!&lIND
oeOM
DOTH
oPTY
osee
!&lIND
oCOM
DOTH
oPTY
osee
IKIIND
DCOM
DOTH
DPTY
Dsce
!&lIND
DCOM
DOTH
oPTY
OSCC
(R1IND
DCOM
DOTH
OPTY
OSCC
Community Service Officer
Cicy of San Rafael
Police Officer
City of San Rafael
Police officer
City of San Rafael
Police Officer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
th roug h _....;1;..;2;;.:/....;3;.;;1,-,/....;2;.;;0....;1;.;;6 __ _
SCHEDULEA (CONT.)
CALIFORNIA 460
FORM
Page 15 of 112
1.0 NUMBER
8)1553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC 311
PER ELECTION
TO DATE
(IF REQUIRED)
12 .70 294 .30
16.30 376.20
16.30 376.20
16 .30 376 .20
16.30 76 .20
FPPC Form 460 (JanJ2016)
FPPC Advice : advic:e@fppc:.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Ratael police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SElF·EIoIPLOYEO. ENTeR NAME
OF BUSINESS)
(IFCOMMITIEEALSOENTERIO.NOMBER) CODE *
11/30/2016 Mfchael Syers
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael. CA 94901
Union member's dues received through
intermedi ary : San Rafael Police Association,
1520 F ifth Avenue San Rafael CA 94901
12/15/2016 Michael Byers
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
union member's dues received through
interm~diary: San RafaE!l Police Association,
12/29/2016
09/30/2016
'Contributor Codes
INO -Individual
COM -Recipient Committee
(other t/1an PTY or SCC)
OTH -Other (e.g., bUSiness entity)
PTY -Potitical Party
SCC -Small Contributor Committee
Fifth
Fifth
Fifth
OOINO
DCOM
DOTH
OPTY
OSCC
!K]IND
DCOM
DOTH
OPTY
OSCC
IXJIND
DeOM
DOTH
OPTY
OSCC
IRJIND
DCOM
DOTH
OPTY
osee
IKJINO
oCOM
DOTH
OPTY
OSCC
Police Off1cer
City of San Rafael
Police Officer
City of San Rafael
Police Officer
City of San Rafael
Dispatcher
City of San Rafael
Dl.spatc er
City of San Rafael
SUBTOTALS
Statement covers pE!riod
from 09/25/2016
throug h _....;1:....2..:./..:;3..:..1.:../..:..2-'01::..6'--__
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
PagE! _--,,-,16=--. of 112
I.D.NUMBER
B)lSS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVETO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
16.30 376.20
16.30 376.20
12,70 294.30
12,70 294,) 0
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.C3.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
san Rafael Police Association Policical Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPlOYEO . ENTER NAME
OF !lUS!NESS)
(I, CQMMmEE. ALSOENlER I D NUMBER) CODE ...
11 OS/2016
11/15/2016
11/30/2016
12/15/2016
Shelly Cade
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
Shelly Cacie
C/o : Sao Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
i~termediary: San Rafael Police Association,
Fifth
Fift:h
Fifth
·Contributor Codes
INO -I ndividual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e .g .. business entity)
PTY -Political Party
SCC -Small Contributor Committee
OOIND
oCOM
DOTH
oPTY
DSCC
IRJIND
DeOM
DOTH
DPTY
osee
OOIND
DeOM
DOTH
OPTY
OSCC
OOIND
DeOM
C]OTH
OPTY
Dsec
[gJIND
DCOM
DOTH
DPTY
osee
Dispatcher
City of San Rafael
Dispatcher
City of San Rafael
Dispatcher
City of Sa ~ Rafael
Dispatcher
Cit:y of San Rafael
Dl.spatc er
Ci:y of San Rafael
SUBTOTAL $
Statement covers period
from _____ 09/25/2016
th rough __ 1.'-'2""/-.:3:...;1",,/...;;;2,-0...;;1,,,6 __ _
seHEDULEA (CONT.)
CALIFORNIA 460
FORM
Page _--=-17,--of 112
I D NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC . 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12 .70 294-30
12 .70 294,30
12. '10 294.30
12.70 294 .30
12.70 294.30
63.5 °1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dolla rs .
NAME OF FILER
San Rafael Police Aesociation Political Action Committee
DATE
RECEIVED
FUll NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
pFCOMMmE". AL$O ENTER 1.0. NUMBER) CODE ..
09 30 2016 Joseph Camins IRJIND
C/o, San Rafael Police Associacion 1520 Fifth
Avenue oCOM
San Rafael, CA 94901 DOTH
Union member's dues rece i ved through 0 PTY
intermediary: San Rafael Police Association, OSCC
1520 F~fth Avenue San Rafael CA 94901
10/20/2016 Joseph Carnine IR]IND
C/o; San Rafael Police Association 1520 Fifth oCOM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues recei ved through 0 PTY
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
IIF SEJ..F,EMFLOYEO. EIITER NM1E
OF 8USINESS)
Officer
City of San Rafael
Officer
City of San Rafael
Statement covers period
from 09/25/2016
th rough _....:1:..;2:..</...:3;.:1:..:./..;:2;..:0..:;1..::6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 18 of 112
I.D .NUMBER
831553
AMOUNT
RECEJVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC 31)
PERELEcnON
TO DATE
<IF REQUIRED)
16.30 376 .20
16.30 376 .20
intermediary: San Rafael Police Association, OSCC
. -~'~----~---------'~~----------------~r-------~~~--------~~=~~----------------GUINO Officer 16 .30 376 .20 11/05/2016
Fifth
11/15/2016
Fitch
11 30 2016
Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
'Contributor Codes
INO -Individual
COM -Recipient Committee
(other tI1an PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
see -Small Contributor CommIttee
DCOM City of San Rafael
DOTH
DPTY
OSCC
@INO
oCOM
DOTH
oPTY
OSCC
!R]IND
OCOM
DOTH
DPTY
OSCC
Officer
Cicy of San Rafael
o lcer
City of San Rafael
SU8TOTAL$
16.]0 376.20
16.30 376.20
81.50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca,gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole do[(ars.
NAME OF FILER
San Rafael Police Associacion Political Action Committee
DATE
RECEIVEO
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IF COM!.4IrrEE./l1.SO ENTER 1.0 NUM~R) CODE *
12/15/2016 Joseph Camins !KIIND
C/o: S8n Rafael police Association 1520 Fifth DCOM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received through D PTY
intermediary: San Rafael Police Association, []SCC
1520 Fifth Avenue San Rafael CA 94901
12/29/2016 Joseph earnins IKlINO
C/o: San Rafael Police ASsociation 1520 Fifth DCOM
Avenue
San Rafae!. CA 94901 nOTH
Union member's dues received through oPTY
intermediary : San Rafael Police Association, OSCC
09jj0!2016 Trevor Carney IKJIND
C/o: San Rafael Police Association 1520 Fifth DCOM
Avenue
San Rafael, CA 9"901 DOTH
Union member' B dues received chrough D PTY
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
~F SELF.EMPLOYED. EN1eR NAt.!E
OF BUSINESS)
Officer
C~ty of San Rafael
Officer
City of San Rafael
Police Off icer
City Of San Rafael
Statement cOllers period
from 09/25/2016
through __ 1::,;2:;,,:/,-,3:...,:1:.,:/...:2:...,:0;,,:1:...,:6 __ _
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page 19 of 112
I.D.NUMBER
aJlSSJ
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -OEC 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.]0 376.20
16 .30 ]76 .20
16.30 360.90
intermediary: San Rafael Police Association, []SCC
1 20 Fift Av n ~t~+'~~~29~UO~ ____ -,~ ________ -4~~ __ ~~~ ____________ ~ ________ ~~~+-________ -,~~~r-______________ ___
10/20/2016 Trevor Carney !:&lIND Police Officer 16.30 360.90
C/o: San Ratael Police Association 1520 Fifth DCOM City Of San Rafael
Avenue
San Rafael, CA 94901 0 OTH
Union member's dues received through 0 PTY
intermediary: San Rafael Police Associar:::ion, OSCC
1520 Fifth Avenue, San Rafael, CA 94901
revor Carney IKJ INO
C/o: San Rafael Police Association 1520 Fifth
Avenue DeOM
San Rafael, CA 94901 DOTH
Union member's dues received through D PTY
in;erm7diary: San Rafael Police Association, DSCC
·Contribulor Codes
INO -Individual
COM -ReCipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
SU8TOTAL$
16.30 360. 0
FPPC Form 460 (Jan/2016)
FPPC Advice: adllice@fppc.ca.goy (8661275 -3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Polit~cal Action Committee
Amounts may be rounded
to whole dollars.
SCHEDULEA (CONT.)
r-----SS~~atre;nmue;n~t~c~o~v~e~rsscp;erlrl~o~d~---I~~IP.~~~~
from __ --'-09"'/:....2:...:5:...:;/....:2;....0..::1..:.6 __ _
through ___ 1_2-.:/_3_1...:./_2_0_1_6 __ _
831553
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPlOYEO. ENTER NAME
OF eUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATNETO DATE
CALENDAR YEAR
(JAN. 1 . DEC. 31)
PER ELEC110N
TO DATE (IF COMMIl TEE. ALSO ENTER 1.0. NUMBER)
11 2016 Trevor Carney
C/o: Sil:l Rafael Police Association 1520 Fifl:h
Avenue
San Rafael. CA 94901
Union member's dues received I:hrough
intermediary: San Rafael Police Association,
Fifl:h
Fitl:h
Fifth
arpenter
C/o: San Rafael Police ASSocia tion 1520 F if th
·Contributor Codes
INO-Individual
COM -Recipient Committee
(other than PTY or SeC)
OTH -Other (e.g .. business entity)
PTY -Political Party
SCC -Small Contributor Committee
CODE·
I&]IND
DCOM
L]OTH
DPTY
osee
[KJIND
DeOM
DOTH
OPTY
osee
IXJIND
DCOM
DOTH
DPTY
Dsce
IXJIND
DCOM
DOTH
D PTY
osce
IKJIND
DeOM
DOTH
D PTY
osec
c e c er
City Of San Rafael
Police Officer
City Of San Rafael
Police Of ficer
City Of San Rafael
Police Officer
City Of San Rafael
r
City of San Rafael
SUBTOTAL $
(IF REQUIRED)
16 .30 360.90
360,90
16,30 360,90
16.30 360.90
81. SO I
FPPC Form 460 (JanI2016)
FPPC Advir::e: advice@fppc.ca.gov (866127S-3n2)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FI LER
San Rafael Police Associa~ion Political Action Committee
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND liP CODE OF CONTRIBUTOR CONTR)BurOR
~F ce.'" MITIEE. ALSO ENTE}l1 0 NUMB ER) CODe "*
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF·SMPLOYEO. ENTER NAME
o~ HUSINESSj
!0/20/2016 Ja~C~k~C~a-~~e~n~t~e-r------------------------------~--~-X-I-N-D-----+O~f~fF~~'c~e~r--
c/o: San Rafael Police Association 1520 Fifth City of San Rafael
Avenue DCOM
San Rafael, CA 94901 DOTH
union member' e dues received through 0 PTY
in~ermediary: San Rafael Police Association, OSCC
152 0 Fifth Avenue San Rafael CA 94901
11/05/2016 Jack Carpenter IRIIND
C/o: San Rafael pol ice As socia t ion 1520 Fit" th 0 COM
Avenue
San Rafael, CA 94901 DOTH
union member's dues received chrough 0 PTY
intermediary, San Rafael Police Association, osce
11/15/2016 Jack Carpenc.er IXJIND
C/o: San Rafael Police ASsociation 1520 Fifth DeOM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
intermediary: San Rafael Police Association, osce
__ --;-_..,.-__ :--1-'1 .. 51..0_);:i.l' v u San Raf 1 A 4 01
11/30/2016 Jack Carpenter IR]IND
C/o: San Rafael Police Association 1520 Fifth ~~ O~
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
inc.e=ediary; San Rafael Police Association, OSCC
1520 Fifth Avenue, San Rafael, CA 94901
Jac Carpenter OOIND
C/o : San Rafael Police Association 1520 Fifth X ~~ O~
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
interme~iary: San Rafael Police Association, []SCC
·Contributor Codes
IND-Individual
COM -Recipient Committee
(other than PTY or seC)
OTH -Other (e .g ., business entity)
PTY -Political Party
SCC -Small Contributor Commit1ee
Officer
Ci~y of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
o locer
City of San Rafael
SU8TOTAL$
Statement covers peri od
from 09/25/2016
through _--=1:..::2,",-/..=.3=.;1 /:...:2:...;0;.:1;.;;6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 21 of 112
1.0. NUMBER
831553
AMOUNT
RECEIVED nilS
PERIOD
CUMULATIVETO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16 .30 376.20
16 .30 376 .20
16.30 376.20
16.)0 376.20
11>. )0 376.20
81 .5°1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc .. ca.gov (866/275..3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Comrnitcee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
IIF SElFEMPlOYED, ENrcR NAME
OF BUSINESS]
IIF COMMITIEE. AL.SOENTERI.D NUMBERI CODE *
12 29/2016 Jack Carpenter
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifch Avenue San Rafael CA 94901
09/30/2016 David Casalnuovo
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
incerm7diary: San Rafael Police Association,
10/20/2016 David Casalnuovo
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association.
1 20 Fifch Aven e San f el 4 01
11/05/2016 David Casalnuovo
c/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
Davl Casa nuovo
C/o: San Rafael Police Association 1520 Fifth
Avenue
San ~fael, CA 94901
union member's dues received through
intermediary; San Rafael Police Association,
·Contributor Codes
INO -Indillidual
COM -Recipient Committee
(other than PlY or seC)
OTH -Other (e_g., business entity)
PlY -Political Party
see -Small Contributor Committee
iKllNO
oCOM
DOTH o PlY
osee
!KIIND
oeOM
DOTH oPTY
osee
lKllND
DeOM
DOTH
DPTY
osee
IKIIND
DCOM
DOTH
OPTY
OSCC
!!lIND
OCOM
UOTH
OPTY
osee
Officer
City of San Rafael
Officer
Cicy of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
o lcer
Cicy of San Rafael
SU8TOTAL$
Statement cOllers period
"om 09/25/2016
th rough _....:1:..;2:..:/-=3:...:1:..!./-=2:...:0-=1-=6 __ _
SCHEDULEA (CONT.)
CALIFORNIA 460
FORM
Page 22 of __ 112
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 311
PER ELECTION
TO DATE
(IF REQUIREDI
16_30 376.20
16.)0 376.20
16. )0 376,20
16.30 )76.20
16,30 376.20
81. 50 I
FPPC Form 460 (Jan/2016)
FPPC Adllice: advice@fppc.ca.goll (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dolla rs.
NAME OF FILER
San Rafael Police Association Political Action Committee
DATE
RECEIVED
11/30/2016
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IF co.IAMITTE!.ALSOENTERIO NUMBER) CODE"
David Casalnuovo IKIINO
C/o: San Ra(ael Police Assodation 1520 Fifth oeOM
Avenue
San Rafael, CA 94901 DOTH
Onion member's dues recei ved through 0 PTY
intermediary: San Rafael Police Association, osce
~~~~~~~1~5~2~0~Fifth Avenue San Rafael CA 94901
12/15/2016 David Casalnuovo ~ INO
C/o; San Rafael police Association 1520 Fifth DeOM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
IF AN INDIVIDUAL, ENTER
OCCUPAnON AND EMPLOYER
(IF SElF-EMPLOVEO. ENTER NAME
OF IhJSINESS)
Officer
City of San Rafael
Officer
City of San Rafael
Statement covers period
from 09/25/2016
~rough __ ~1~2~/~3~1~/~2~0~1~6~ __ ___
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page ____ 2L. of. ...!lL
I.D.NUMBER
831!>!>3
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 -DEC _ 31)
PER ELECTION
TO DATE
!IF REQUIRED)
16 .30 376 .20
16 .)0 376 .2 0
12/2912016
intermediary: san Rafael Police Association, []SCC
~0 .~·~~~~~~w-~~~~~~~L-____ -+ ________ ~~~ __________________ 4-____________ -+ ______________ -+ ______________ __
David Casalnuovo IiU INO Officer
C/o: San Rafael Police Association 1520 Fifth oeOM City of San Rafael
Avenue
San Rafael, CA 94901 DOTH
Onion member' s dues received through 0 PTY
intermediary; San Rafael Police Association, osec
. n Rat 1 4
09/30/2016 Edward Chiu IRl NO
C/o; San Rafael Police Association 1520 Fifth OX ~OM
Avenue
San Rafael , CA 94901 DOTH
Union member's dues received through 0 PTY
intermediary; San Rafael Police Association, OSCC
1520 fifth Avenue, San Rafael, CA 94901
10 IE war l.U IRJINO
C/o: San Rafael Police Association lS20 fifth
Avenue oeOM
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
intermediary: San Rafael Police Association, DSCC
'Contributor eodes
INO -Individual
COM -Recipient Committee
(other than PTY o( SeC)
OTH -Other (e _g _. business entity)
PTY -Political Party
see -Small Contributor Committee
Officer
City of San Rafael
o J.cer
City of San Rafael
SUBTOTAL $
16 _30 376.20
16_30 376,20
16_30 376,20
81.50 1
FPPC Form 460 (Jani2016)
FPpe Advice: advic.e@fppc .c.a.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police ASsociation Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPLOVEO. EIflER NAME
OF 6US!NESS)
(IF COIo!MITTEE. ALSO ENTER 1.0 . NUMBERI CODE *
11/05/2016 Edward Chiu
C/o: San Rafael Police Association 1520 Fifth
Avenue
San ~fael, CA 94901
Union member'S dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
11/15/2016 Edward Chiu
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
interm7diary: San Rafael Police Association,
12/15/2016
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e .g ., business entity)
PTY -Political Party
SCC -Small Contributor Committee
Fifth
Fifth
Fifth
OOINO
oeOM
DOTH
oPTY
osce
OOINO
oeOM
DOTH
oPTY
oscc
I2UIND
oeOM
DOTH
oPTY
Osee
IKlIND
oeOM
DOTH
oPTY
oSCC
iRllND
oCOM
DOTH
OPTY
osce
Of fi cer
City of San Rafael
Officer
City of San Rafael
Officer
Cicy of San Rafael
Officer
City of San Rafae~
o l.cer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
throug h _-,1",2::..:/'-.:3:....:1,-,/-,,2:....:0:..::1;...;6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 24 of 112
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. , • DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16 .30 376 .20
16 ,30 376,20
16.30 376.20
16 .30 376.20
16.30 376 .2 0
81. 50 I
FPPC Form 460 (JanJ2016)
FPPC Advice: advice@fppc.ca.gov (8661275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME . STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF·E.\I.PLOYEO. ENTER NAME
OF BUSINESS)
IIF COMIAIll"EE. AlSO EIlTER 1.0 NUIABERI
09/30/2016 Robert Cleland
C/o: San Rafael Police Association 1520 Fifth
Avenue
San ~fael, CA 9~901
Union member's dues received through
intermediary : San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
10/20/2016 Robert Cleland
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
inte~ediary : San Rafael Police Association,
11/05/2016 Robert Cleland
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 9490~
Union member's dues received chrough
inte~ediary : San Rafael Police Association,
~ Ftfth Avenue. San R~~ 1
11/15/2016 Robert Cleland
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
in~ermediary: San Rafael ?olice Association,
1520 pifth Avenue, San Rafael, CA 94901
Ro ert C e an
C/o : San Rafael Police Association 1520 Fifch
J\venue
San Rafael , CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
'Contributor Codes
IND -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g .. business entity)
PTY -Political Party
sec -Small Contributor Committee
CODE ,.
OOIND
oeOM
DOTH
oPTY
osee
IRJIND
DeOM
DOTH
OPTY
OSCC
IgjIND
DeOM
DOTH
oPTY
osce
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
'--~::-77-
IRlIND officer nCOM City of San Rafael
DOTH
DPTY
osee
!!lIND
oeOM
DOTH
OPTY
OSCC
o .l.cer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
through __ ~1~2~/~3~1~/~2~0~1~6~ __ ___
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page _-=:..:25~ of 112
I.D.NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376 .20
16.30 376 .20
16.30 376 .2 0
376.20
16.30 37 .20
81.S01
FPPC Form 460 (Jan/2016)
FPPC Advice: advicc@fppc.ca.goll (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Accion Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODe OF CONTRIBUTOR CONTRIBlJTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPlOYED. EIflER NAME
OF BUSINESS)
(IFCO~MlnE"-ALSoEN~RI 0 NUMBERI CODE *
12 15 2016 Robert: Cleland
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Onion member's dues received through
intermediary' San Rafael Police Association,
1520 Fifth Ave n ue San Rafael CA 94901
12/29/2016 Robert Cleland
C/o: San Rafael Police Assoc~ation 1520 Fifth
Avenue
San Rafael, CA 94901
unio~ member's dues received through
interm:diary : San Rafael Police Association,
09/30/2016 Chr1stopher Coale
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received ehrough
intermediary: San Rafael Police Association,
1520 Fife v n A 4 1
10/20/:2016 Christopher Coale
C/o: San Rafael Police Association 1520 Fifth
Avenue
·Contributor Codes
IND -Individual
COM -Recipient Committee
(other than PlY or SCC)
OTH -Other (e.g .. business entity)
PTY -Political Party
SCC -Small Contributor Committee
IRJIND
DeOM
DOTH
DPTY
osee
I29IND
DeoM
DOTH
oPTY
osee
IXlINO
oeoM
DOTH
DPTY
osee
[XJIND
oeOM
DOTH
oPTY
osec
!KlIND
DeOM
DOTH
DPTY
osee
Officer
City of San Rafael
Officer
Cicy of San Rafael
Sergeant
Ci~y of San Rafael
Sergeane
City of San Rafael
Sergeant
City of San Rafael
SUBTOTAL $
Statement covers period
from __ " 09/25/2016
through _...;1;;.;2;;..:/...:J;.;1~/...:2:..:0-=1-=6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 26 of 11:2
LD. NUMBER
8Jl553
AMOUNT
RECEiVED THIS
PERIOD
CUM ULATIVE TO DATE
CALENDAR YEAR
(JAN. , -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
16 .30 376.20
16 .30 376.20
16.30 376.20
16.30 )76 .20
81.50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (8661275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
IIF SELF·E.I.IPlOYED. ENTER NAME
OF aUS'N CSS)
(IFCCMMlnEE. ALSO ENTER 1,0 NUM8ER) CODE *
11 IS 2016
11/30/2016
12/15/2016
12/29/2016
·Contribulor Codes
IND -I ndividual
COM -Recipient Committee
(other than PTY Dr SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
Association 1520 Fifth
Fi.fth
Fifth
Fifth
Fifth
/F!IND
DCOM
DOTH
DPTY
OSCC
OOIND
[jCOM
DOTH
DPTY
OSCC
IXJIND
oCOM
DOTH
oPTY
OSCC
IRJIND
DeOM
DOTH
DPTY
osee
!K]INO
DCOM
DOTH
DPTY
osee
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Sergeant
City of San Rafael
O~~l.cer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/:2016
through __ ~1~2~/~3~1~/~2~0~1~6 ____ ___
SCHEDULE A (CaNT)
CALIFORNIA 460
FORM
Page 27 of _~
1.0 . NUMBER
631SS3
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAA
(JAN . , • DEC . 31)
PERELECnON
TO DATE
(IF REQUIRED)
16 .30 376.20
16.30 376 .20
16.]0 376.20
16.30 376.20
16.30 376.20
81. SO I
FPPC Form 460 (Janl2016)
FPPC Advice: adv!ce@fppc.ca.gov (866/275-3772)
-• -~. < .• -. - -~. - .
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I D. NUMB€R) CODE *
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOVER
(IF SELF·EMPLOYED, ENTEIt NAME
OF BUSINESS)
10/20/2016 TholT.as Collins
C/o : San Rafael Police Association 1S20 Fitth
Avenue
San Rafael, CA 94901
/KlINO
DCOM
DOTH
DpTY
Osee
Officer
Ci~y of San Rafael
Statement covers period
from 09/25/2016
th roug h _....;1::,;2",/,-,3:.,:1",,/..,:2:.,:0;,.::1;,.::6 __
SCHEDULE A (CaNT)
CALIFORNIA 460
FORM
Page 28 of 112
LD. NUMBER
8JlSS3
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 . DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.)0 376.20
Onion member's dues received through
in~ermediary; San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
11/05/2016 Thomas Collins ---+~~-----------------+--------~~~--------~~~~---------------!KlINO Officer 16.)0 376.20
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Onion member's dues received through
intennediary; San Rafael Police ASSOCiation,
11/15/2016
11/30/2016
·Contributor Codes
INO -Individual
'F
COM -ReCipient Committee
(other than PTY or seC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
Fifth
Fifth
Fifth
DCOM City of San Rafael
DOTH
oPTY
osce
!KlIND
oeOM
DOTH
DPTY
osce
!KlINO
oCOM
DOTH
oPTY
osee
[KlIND
DeOM
DOTH
npTY
osee
Officer
City of San Rafael
Officer
City of San Rafael
o J.cer
City of San Rafael
SU8TOTAL$
16.30 376.20
16.)0 376.2Q
16.)0 376.20
81,50 1
FPpe Fonn 460 (Janf2016)
FPPC Advice: advice@fppc.ca.goll (866/275-3772) -i'._._ ~ ~ _ ~ __ ,_
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FI LER
San Rafael Police Association Political Action committee
Amounts may be rounded
to whole dollars.
DATE
RECENED
FU Li NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF 5aF·EMPLQYED. ENTER NAME
OF aUSINESS)
(IF COMMmEE, ALSO ENP£R I 0, NUMBER> CODE *
12/29 2016 '':'ho"mas Collins
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael ~olice ASsociation,
1520 Fifth Avenue San Rafael CA 4901
09/30/2016 Jenna Cocca
c/o San Rafael Police Associacion 1520 Fifth
Avenue
San Rafael, CA 94901
Union membe~'s dues received through
intermediary: San Rafael Police Association,
10/20/2016
11/05/2016
11 15 2016
'Contributor Codes
IND -I ndividual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g .• business entity)
PTY -Political Party
SCC -Small Contributor Committee
Po.l:ce Association 1520 Fl.Eth
94901
Police Association 1520 Fifth
Association,
4
IKIIND
oCOM
DOTH
DPTY
OSCC
!!lIND
DCOM
DOTH
DPTY
OSCC
IXJIND
DeOM
DOTH
DPTY
OSCC
IKlIND
DCOM
DOTH
DPTY
[JSCC
IRIIND
DCOM
DOTI-l
DPTY
OSCC
Office"
City of San Rafael
Communications Dispatcher
City of San Rafael
Communications Dispatcher
City of San Rafael
Communicat1ons Dispatcher
City of San Rafael
COmmun1cat10nS 01spacc er
City or San Rafael
SUBTOTAL $
Statement covers period
from _. __ 0_9....:/_2_S---,-/_2_0_1_6_
th rough __ 1_2....:/'---3_1....;/_2_0_1_6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page :2 9 of _----'1"'1"'2"--
LD. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
12.70 222.30
12.70 222.30
12.70 222.30
12.70 222.30
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRI8UTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF S~LF-EI.IPLoYED. ENTER NAME
OF eU$lNESS)
QFCC!.l!AmEaAlSOENTERI.O NUM8ER) CODE *
11 30 2016 Jenna Cotta
c/o San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
1i/15/2016 Jenna Cotta
12/29/2016
c/o San Rafael police Association 1520 fifth
Avenue
San Rafael, CA 94901
Uoion meIDber's dues received through
interm7~iary: San Rafael Police Association,
09/)0/2016 Ryan De Marta
C/o: San Rafael Police ASsociation 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
1ntermediary: San Rafael Po11ce Association,
1520 Fifth Avenue, San Rafael, CA 94901
10 20 2016 Ryan De Marta
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafa~l, CA 94901
Union member's dues received through
inte~ediary: San Rafael Police Association,
'Contributor Codes
I NO -Individual
2 .
eOM -Recipient Committee
(olher than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
IKJIND
nCOM
DOTH
OPTY
osee
!!lIND
OCOM
DOTH
OPTY
osee
IKIIND
OCOM
DOTH
OPTY
OSCC
IKJIND
OCOM
DOTH
OPTY
OSCC
jIDlND
DCOM
DOTH
OPTY
OSCC
Communications Dispatcher
City of San Rafael
Communications Dispatcher
City of San Rafael
Communications Dispatcher
City of San Rafael
Officer
City of San Rafael
o tlCer
City of San Rafael
SUBTOTAL $
Statement covers pe rlod
from 09/25/2016
~rough __ ~1~2~/~3~1~/~2~0~1~6 ____ __
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page )0 of 112
to. NUMBER
8315S3
AMOUNT
RECENED THIS
PERIOD
CUMULATtVETO DATE
CALENDAR YEAR
(JAN. 1 • DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12.70 222. )0
12.70 222.30
12.70 222.30
16.)0 376.20
16.)0 376.20
FPPC Form 460 (Jan/2016)
FPPC Advice: adllice@fppc.ca.gov (8661275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael ?olice Association Policical Act~on committee
Amounts may be rounded
to wnole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL , ENTER
OCCU PATION AND EMPLOYER
(IF SElf-EMPLOYED. EN1l:R NAME
OF DUSINESS)
(fl'COM!.4ITTEE .... l50ENn:RID NUMBERI CODE *
11/05/2016 Ryan De Marta
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Vnioa member's dues received through
intermediary: San Rafael Police Association,
1520 F i fth Avenue San Rafael CA 94 01
11/15/2016 Ryao De Marta
11/30/2016
12/15/2016
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received chrough
intermediary : San Rafael Police Association,
. F
Fifch
Fifth
/XJIND
DCOM
DOTH
DPTY
f1SCC
IEJIND
DeOM
DOTH
OPTY
oscc
IKJIND
DCOM
DOTH
DPTY
OSCC
IR]IND
DCOM
DOTH
OPTY
osce
Off~cer
city of San Rafael
Officer
C~ty of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Statement covers period
from 09/25}2016
through _ 12/31/2016
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page _--=.:31=---of 112
1,0 . NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC , 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16 .30 376.20
16.30 376.20
16.30 376 .20
16,30 376 .20
~~~~~~~~~~~------~--~--IN-D-----1~O~~l~ce~r~----------------~----------~6 ·.30~--------~3~7~6-.~2~O~-----------------
<'lfth City of San Rafael
12 29 2016
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e .g ,. business entity)
PTY -Political Party
SCC -Small Contributor Committee
oCOM
DOTH oPTY
OSCC
SUBTOTAL $ 81. 50 I
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3n2)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Associacion Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
I (IFCCMMITrEE. AlSO ENTER I.D NUMBER) CODe *
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELf·EM~lOYEO. ENTER NAME
OFBIJS!NESS)
09/30/2016 Christian Diaz
C/o: San Rafael Police Association 1520 FiEch
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 4901
10/20/2016 Christian Diaz
C/o, San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union mel!IDer'S dues received t::hrough
int::erm~diary: San Rafael Police Assoc~ation,
11/15/2016
·Contributor Codes
I NO -Individual
COM -Recipient Committee
(other than PTY or Sec)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
Fifth
Fifth
Fifth
IKIIND
DeOM
DOTH
OPTY
o sec
!!lIND
o eOM
DOTH
OPTY
osee
®IND
OCOM
DOTH
OPTY
OSCC
IKlIND
OCOM
DOTH
OPTY
OSCC
IR]IND
oeOM
DOTH
OPTY
osee
Police Corporal
Cit::y of San Rafael
Police Corporal
C~ty of San Rafael
Police Corporal
City of San Rafael
Police Corporal
City of San Rafael
SU8TOTAL$
Statement covers period
from 09/25/2016
~rough ___ 1_2~/~3~1~/_2~0~1~6 ____ ___
SCHEDULE A (eONT.)
CALIFORNIA 460
FORM
Page 32 o f 112
I.D.NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(.JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
16,30
16.30 376.20
16.30 3"76.20
1 .30 376.20
81.50 1
FPPC Form 460 (JanI21l16)
FPPC Advice: advice@fppt.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Policical Action Commiccee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS ANO ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SElF·EMPLQVE!l. EIflER NAME
OF 6US!NESS)
(IFCCW.MITTEE .Al.SOENTeRI.D.NUM6El1I CODe ...
12 15 2016
12/29/2016
09/30/2016
10/20/2016
Christl.an Oiaz
c/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
1520 Fifth Av nue Sao Rafael CA 94901
Christian Diaz
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
Fifth
Fifth
Fifth
·Contributor Codes
IND-Individual
COM -Recipient Committee
(other than Pl'\' or SCC)
OTH -Other (e.g ., business entity)
PTY -Political Party
SCC -Small Contributor Committee
IRJIND
oCOM
DOTH
oPTY
OSCC
IKJ IND
DCOM
DOTH
oPTY
Dsec
IKl IND
DeOM
DOTH
DPTY
osee
IRlIND
DeOM
DOTH
oPTY
osee
IKJIND
oCOM
DOTH
DPTY
osce
Police Corporal
City of San Rafael
Police Corporal
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
o lcer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
through _...;;.1;:.:2,-,/...;;3;..;;1;.:./...;;2;..;;0..::1..::6 __ _
SCHEDULEA (CONT.)
CALIFORNIA 460
FORM
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CAlENDAR YEAR
(JAN . 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16 .30 376 .20
16 ,30 376 .20
16.30 376.20
16.30 376.20
16.30 376.20
Bl.50 1
FPPC Form 460 (Janl2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Poli~ical Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SElF. EMPLOYED. ENTER "'AMi:
(lFCCMMmEE.ALSOENT8H.D. HUMBER) CODE ..
11 15 2016 Christopher Duncan
C/o: San Rafael ~olice Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 4901
11/30/2016 Christopher Duncan
12/15/2016
C/o : San Rafael Police Association 1520 Fif~h
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Association, .'"
Fifth
12/29/2016 Christopher Duncan
C/o : San Rafael ~olice Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
09 30 2016 Scott E r.l.e
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
union member's dues received through
intermediary ; San Rafael Police Association,
·Contributor Codes
INO -Individual
. 4
COM -Recipient Committee
(olher than PTY or SCC)
OTH -Other (e.g., business entily)
PTY -Political Party
SCC -Small Contributor Comm ittee
IR)IND
oCOM
DOTH
oPTY
osee
~IND
OCOM
DOTH
OPTY
OSCC
IR)IND
oeOM
DOTH
OPTY
osee
IK)IND o COM
DOTH
DPTY
OSCC
IKJIND
DCOM
DOTH
OPTY
OSCC
OF 8US4NESS)
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Sergeant
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
throug h _....:1::..;2:..:/....:3;...;1;..:;/....:2:....;0..;;;1..;;;6 __ _
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page _-=-34=--of l.l.2
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376 .20
16 .30 376 .2 0
16.30 376.20
16.30 376 .20
16.30 376.20
81 .50 1
FPPC Form 460 (Janl2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Association Political Action Committee
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IF COMMITTEE. ALSO ENTEl'I I 0 NUMBER) CODE *
10/20 2016 Scott Eberle IRJIND
C/o: San Rafael Police ASsociation 1520 Fifth oCOM
Avenue
San Rafael, CA 94901 DOTH
Union member' s does rece i ved through 0 PTY
incermeciiary: San Rafael Police Association, OSCC
1520 Fifth Avenue San Ra fael CA 94901
11/05/2016 Scott Eberle IRJIND
C/o: San Rafael Police Association 1520 Fifth DCOM
Avenue
San Ra fael, CA 94901 DOTH
union member'S dues rece i ved through 0 PTY
interm~diary: San Rafael Police Associacion, OSCC
11/15/2016 Scott Eberle IRJIND
C/o, San Rafael Police Association 1520 Fifch o COM
Avenue
San RafaeL CA 94.901 DOTH
Union member's does received chrough 0 PTY
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF saF·E/.IPLOYEO. ENTeR NAI..1E
OF BUSINESS)
Sergeant
City of San Rafael
Sergeanc
City of San Rafael
Sergean:
City of San Rafael
Statement covers period
hom 09/25/2016
throug h __ 1_2-,/_3_1-,1_2_0_1_6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 35 of _-,1",1=..:2=--
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULAnve TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
16.30 376.20
16.30 376.20
intermediary; San Rafael Police Associat~on, [JSCC
~~77~~~~1520 Fifth Avenue. San Rafael~~A~~~~ ______ ~ __________ ~~~ ______________________ -+ __________ ~~~r-__________ ~~~+-________________ __
11/30/2016 Scott Eberle oolND Sergeant 16.30 376.20
C/o: San Rafael Police Association 1520 Fifth X City of San Rafael
Avenue nCOM
San Rafael, CA 94.90l [J OTH
Union member's dues received Chrough [J PTY
intermediary: San Rafael Police Association, [JSCC
1520 Fifth Avenue, San Rafael, CA 94901
12 15 2016 Scott E: er e 001 0
C/o: San Rafael Police Association 1520 fifth X N
Avenue [J COM
San Rafael, CA 94901 [JOTH
Union member's dues received chrough DPTY
intermediary : San Rafael Police ASsocia~ion, [JSCC
·Contributor Codes
IND -Individual
. 949Q1
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g, business entity)
PTY -Political Party
SCC -Small Contributor Committee
Sergeant
City of San Rafael
SUBTOTAL $
16.30 :1 76.20
81. SO I
FPPC Form 460 (Jan/2016)
FPPC Advice: adv1ce@fppc.ca.gov (8661275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME. OF FILER
San Rafael Police Associacion Policical Action Committee
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IF COMMITTEE. ALSO ENTER I 0 NUMBER) CODE ...
12 29/2016 Scon Eberle IKIINO
C/o : San Rafael Police Association 1520 Fifth ~~ O~
San Rafael. CA 94901 nOTH
Union member's dues received through 0 PTY
inc.ermediary : San Rafael Police Association, osee
1520 Fifth Avenue San Rafael CA 94901
09/30/2016 Sandra Felix Ahumada IRIIND
C/o: San Rafael Police Association 1520 Fifth oCOM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
interm7diary: San Rafael Police Association, OSCC
IF AN INDIVIDUAL , ENTER
OCCUPATION AND EMPLOYER
(IF saF·EMPLOVEO. ENTER NAME
Of BUSINESS)
Sergeant
City of San Rafael
Police Officer
City Of San Rafael
Statement covers peri ad
ITom 09/25/2016
th rou gh _...:1:..:2;.:../.=.3.::.1 :....;/2::..:0:..:1:..:6~ __
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page _._.li....-of 112
1.0. NUMBER
831553
AMOUNT
RECENED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 -OEC 31)
PER ELECnON
TO DATE
(IF REQUIRED)
16 .30 376.20
16.30 110 .10
~~------+---------~~--~~------------+---------~--+-----------~~---------------09/30/2016 Kevin Finerty IRJ IND Police Officer 16.]0 207.90
C/o: San Rafael Police Association 1520 Fifth UCOM City Of San Rafael
Avenue
San Rafael, CA 94901 DOTH
Uni on member'S dues rece i ved through 0 PTY
intermediary: San Rafael Police Association , OSCC
~77~~~~~~~~' ~~n 4 01
10/:20/2016 Kevin Finerty IRJIND
C/o: San Rafael police Association 1520 Fifth X
Avenue oeOM
San Rafael, CA 94901 DOTH
union member's dues rece i ved th rough 0 PTY
intermediary: San Rafael Police Association, osee
1520 Fifth Avenue, San Rafael, CA 94901
11 05 2016 Kevln Fl.nert y IvIIND
C/o, San Rafael Police Association 1520 Fifth ~
Avenue DeOM
San Rafael, CA 94901 DOTH
Union member' s dues received through U PTY
intermediary: San Rafael Police Association, LJsce
·Contributor Codes
IND -Individual
COM -Recipient Committee
(olher than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
Police Officer
City Of San Rafael
SUBTOTAL $
16.30 207 .90
16.30 207.90
81. 50 I
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (B66/275-3n2)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole do liars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDlVlDUAL, ENTER
OCCUPAnON AND EMPLOYER
(IF SElF-EMPLOYED. ENlER NAME
OF 5USINESS)
(IFCOMMITT~E.ALSOENTERI.D NUMIlERI CODE *
11/1~,!2016 Kevin Finerty
C/o: San Rafael Police Association 1520 FiEth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 F ifth Av enue San Rafael CA 94901
11/30/2016 Kevin Finerty
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
~nterm7diary: San Rafael Police Association,
12/15/2016 Kevin Finerty
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues receJ.ved through
intermediary: San Rafael Police Association,
1 ·lft A a
12/29/2016 Kevin Finerty
c/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
09 30 2016 Scott F1S er
C/o: Sil~ Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
interm7 dlary: San Rafael Police Association,
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
!KlIND
oeOM
DOTH
UPTY
osee
!KlINO
OCOM
DOTH
OPTY
osec
IXIINO
OCOM
DOTH
OPTY
oscc
!KlIND
oeOM
DOTH
OPTY
OSCC
!KlIND
OCOM
DOTH
D PTY
OSCC
Police OffJ.cer
City Of San Rafael
Police Officer
City Of San Rafael
Police Officer
City Of San Rafael
Police OffJ.cer
City Of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
th ro ugh _-=1:..;:2"-/.::.3=-1/<....:2:.,;0:..;:1:..;:6'--__
SCHEDULEA (CONT.)
CALIFORNIA 460
FORM
Page 37 of 112
LD.NUMBER
831553
AMOUNT
RECENED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 207.90
16.30 207.90
16.30 207,90
16.30 207.90
16, 0
81. SO I
FPPC Form 460 (Jan/2016)
FPPG Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Assoc:iat:ion Polit:ical Acr:ion commit:r:ee
Amounts may be rounded
to whole dollars.
DATE
RECE IVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF saF·E!.4pl.OYEO. ENTER NAME
Of B(JSI"'ESS)
(IFCOMMrnE€.ALSO~1 0 NUMe6l) CODE *
10/20/2016 Scot:!: Fisher
C/o : San Rafael Police ASsociation 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary · San Rafael Police Association,
1$20 Fifth Avenue San Rafael CA 94901
11/05/2016 Scott Fisher
11/15/2016
11 /30/ 2016"
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
union member's dues received through
intermediary: San Rafael Police Association,
" F
FiEth
Fifth
Avenue
San Rafael, CA 94901
Union member'S dues received through
intermediary: San Rafael Police Associar.ion ,
1520 fifth Avenue, San Rafael , CA 94901
12 15 2016 Scott f~sher
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police A9Bociat~on ,
'Contributor Codes
INO -Individual
2 F ·
COM -Recipient Committee
(other than PTY or seC)
OTH -Other (e.g., business entity)
PTY -Polillcal Party
sec -Sma!) Contributor Committee
OOIND
OCOM
DOTH
OPTY
OSCC
!R]IND
DCOM
DOTH
OPTY
osee
IXJIND
nCOM
DOTH
DPTY
osce
IRJIND
DCOM
DOTH
OPTY
OSCC
!!lIND
OCOM
DOTH
OPTY
OSCC
<,alice Officer
City Of San Rafael
Police Officer
City of San Rafael
Police Officer
City of San Rafael
Police Officer
City Of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
through __ 1:....2,-,/....:3....:1...:./....;2:....0..;.1....:6 __ _
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page 36 of 112
1.0 . NUMBER
631553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 • DEC . 31,
PER ELECTION
TO DATE
(IF REQUIRED)
16.30
16.30 201.30
16 .30 201.30
16 .30 201 .30
15 .30 201.30
81. 50 I
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael ?ol~ce Association ~olitical Action Committee
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IF COMMITTEE. ALSO EI>JTER I 0 NUMBER) CODe *
12/29/2016 Scoel Fisher IKIIND
C/o : San Rafael Police ASSoc1ation 1520 Fifth
Avenue DeOM
San Raiael, CA 94901 DOTH
Jnion member' e dues received through LJ PTY
intermeaia~: San Raiael Police Association, DSCC
1520 Fifth Avenue San Rafael CA 94901
09/30/2016 Anna Fulgado IKIINO
C/o : San Rafael Police Association 1520 Fifth DCOM
Avenue
San Rafael, CA 94901 DOTH
Union member's due 5 rece i ved throug~ 0 PTY
interm~diary : San Rafael Police Association, osce
10/20/2016 Anna Fulgado ~IND
C/o, San Rafael Police Association 1520 Fifth DeOM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received .:hrough OPTY
IF AN INDIVIDUAL, ENTER
OCCUPAnON AND EMPLOYER
QF S~LF·EMPLOYED. ENT8l NAME
OF BU$1NESS)
Police Officer
City Of San Rafael
Dispatcher
City Of San Rafael
Dispatcher
City Of San Rafael
Statement covers period
from 09/25/2016
through ___ l~2~/~3~1~/_2~O~1~6 ____ ___
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 39 of 112
1.0. NUMBER
831553
AMOUNT
RECENEO THIS
PERIOD
CUMULAnvETO DATE
CALENDAR YEAR
(JAN. 1 -DEC . 31)
PERELEcnON
TO DATE
(IF REQUIRED)
16.30 201.]0
12 .70 282.30
12_ 70 262.30
lntermediary: San Rafael Police Association, OSCC
__ ~~~~~~~~~-Q~F~l~'f~t~h~A~V~~~~~CA~~9~4~9~ ______ ~ __________ ~~ __ ~~ _______________ +-____________ ~+---------~~~~-------------------
1.1/05/2016 Anna Fulgado OOIND Dispatcher 12-70 2B2.30
C/o; San Rafael Police Association 1~:l0 Fifth OX COM City Of San Rafael
Avenue
San Rafael, CA 94901 DOTH
union member's dues recei ved through 0 PTY
intermediary : San Rafael Poli.ce Association, OSCC
1520 fifth Avenue, San Rafael, CA 94901
Anna Fu ga 0 OOIND
C/o ; San Rafael Police Association 1520 Fifth X
Avenue OCOM
San Rafael, CA 94901 LJOTH
Union member's dues recei ved through 0 PTY
intermediary: San Rafael Pol~ce Association, [JSCC
·Contributor Codes
INO-Individual
COM -Recipient Committee
(other than PTY or seC)
OTH -Other (e_g .. business entity)
PTY -Political Party
SCC -Small Contribulor Committee
Dlspatc er
City Of San Rafael
SUBTOTAL $
12 .70 282 .30
FPPC Form 460 (JanI2016)
FPPC Advice: advice@fppc.ca.gov (8661275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPLOYED. EI>1TER NAME
OF BUSINESS)
(IF CQMMmE.E, AlSO ENTER I.D. NUMB~R) CODE *
11/30/2016 Anna Fulgado
C/o : San Rafael Police Associa tion 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
~~~~~~~15'-O Fifth Avenue San Rafael CA 94901
12/15/2016 Anna-Fulgado
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
.12/29/2016
09/)0/2016
·Contributor Codes
I NO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entily)
PTY -Polit ical Party
sec -Small Contributor Committee
Fifth
Fifth
Fifth
IKIIND
oeOM
DOTH
oPTY
osee
!KIIND
oCOM
DOTH
o PTY
osec
\XJIND
OCOM
DOTH
DPTY
osce
IR]IND
DCOM
DOTH
DPTY
osee
I!)IND
DeOM
DOTH
OPTY
osec
Dispatcher
City Of San Rafael
Dl.spatcher
City Of San Rafael
Dispatcher
City Of San Rafael
Police Officer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
through __ 1",2",/'-.:3:....:1:..:/--,2:....:0-=1:....:6 __ _
SCHEDULE A (CaNT.}
CALIFORNIA 460
FORM
Page 40 of 112
1.0 . NUMBER
831553
AMOUNT
RECEIVED THIS
PERIO~
CUMULAnvE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC . 31)
PERELEcnON
TO DATE
(IF REQUIRED)
~2.70 282 .30
12 .70 282.30
12.70 282 .)0
16.30 376.20
6.30 376 .20
FPPC Form 460 (Jan/2C16)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole do liars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR !F AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPLOYED, ENTER NA~E
OF BUSINESS)
(IF COMMITTEE, AlSO ENTER I D. NUt.!BER) CODE *
11 OS/2016 Christopher Fuller
C/o; San Rafael Police Association 1520 Fifth
Avenue
San Rafael, LA 94901
Union member's dues rece1ved through
intermediary: San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
11/15/2016 Christopher Fuller
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
interm7diary: San Rafael Police Association,
11/)0/2016 Christopher Fuller
C/o; San Rafael Police Associacion 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary' San Rafael ~olice Association,
1520 Fifch Avenue San Rafael CA 4 01
12/15/2016 Chris copher Fuller
c/o: San Rafael Police AssociaLion 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 rcifth Avenue, San Rafael, LA 94901
C rlstop er Fu ier
c/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
15?~r~th Ayenue
·Contributor Codes
IND -Indwidual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
IRIIND
[JCOM
DOTH
oPTY
OSCC
IRIIND
oCOM
DOTH
oPTY
OSCC
IiIIND
LJCOM
DOTH
OPTY
OSCC
IRIIND
OCOM
DOTH
OPTY
OSCC
IKJIND
OCOM
DOTH
OPTY
USCC
Police Officer
City of San Rafael
Police Officer
Ci~y of San Rafael
Police Officer
Cicy of San Rafael
Police Officer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2G16
~rough __ ~1~2~/3~1~/2~0~16~ ____ ___
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page 41 of __ -=1::..:1::..:2=--
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 • DEC. 311
PER ELECTION
TO DATE
(IF REQUIREDI
16.30 376.20
16.30 376.20
16.30 376.20
16.30 376.20
16.30 ]76.20
81,50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole doUars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDNIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPLOYED. ENTER NAME
OF euslNEssl
(IF COMMI TrEE. ALSO ENTER to NUMBERI CODE *
09/30/2016' Salvatore Garanzini
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
10/20/2016 Salvatore Garanzini
11/0 5 /2016
c/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
Fifth
11/15/2016 Salvatore Garanzini
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
Sa vatore Garanz~n~
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary, San Rafael Police Association,
·Contributor Codes
INO -Ind ividual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g" business entity)
PTY -Political Party
SCC -Small Contributor Committee
IK]IND
DCOM
DOTH
DPTY
Dsce
IKIIND
DeOM
DOTH
OPTY
osee
IXlIND
DCOM
DOTH
DPTY
osce
!RlIND
DCOM
DOTH
OPTY
osee
IKIIND
DCOM
DOTH
OPTY
osee
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Officer
C1ty of San Rafael
o l-cer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
through _' 12 /31/2016
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page 42 of 112
I D,NUMBER
83155)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN, 1 -DEC, 31)
PERELEcnON
TO DATE
(IF REQUIRED)
16.30 376.20
16.30 376,20
16.30 3 7 6,20
16.30 376,20
16,30 )7 .20
81. 50 I
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc,ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FI LER
San Rafa e l ~olice As60cia~ion Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(tFCOM'-1ITTE;:' ALSO ENTEIl 1.0 N\!I.IBER) CODE *
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(I F SELf·EMPlOYED. EN'TCR NAME
OF BUSINESS)
09/30/2016
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other Ihan PTY or SCC)
OTH -Other (e .g ., business entity)
PTY -Political Party
SCC -Small Contributor Committee
Fifth
Fifth
Fift.h
Fifth
Fi fth
(RJIND
DCOM
DOTH
OPTY
OSCC
!!lIND
nCOM
DOTH
DPTY
osee
IKJINO
oCOM
DOTH oPTY
Osee
IKJIND
oCOM
DOTH
oPTY
OSCC
IK)IND
DCOM
UOTH
OPTY
OSCC
San Rafael
Officer
Cit.y of San Rafael
San Rafael
San Rafael
SUBTOTAL $
Statement cOllers period
from __ --'-0"""'9/:....2.;..;5'-'/...;:2...;:0...;:1...;;;6 __ _
through __ 1;0;2;;..:/'-'3:....:1'-'/...;:2...;:0...;:1;.;;6'--__
AMOUNT
RECEIVED THIS
PERIOD
16 .30
16.30
Bl .50 1
83~S S3
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 -DEC. 31)
376 .20
376.20
SCHEDULE A (CaNT.)
PER ELECTION
TO DATE
(IF REQUIRED)
FPpe Form 460 (Jan/2016)
FPPC Adllice: adllice@fppc.ca.goll (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL . ENTER
OCCUPAnON AND EMPLOYER
(IF SElf·EMPLOYEO. ENTER NAME
OF BUSINESS)
(IF COMMlnee. ALSO ENTER I 0 NUMBER) CODE *
11/15 2016 Michael Garrison
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary , San Rafael Police Associa~ion,
1520 fifth Avenue San Rafael CA 94901
11/)0/2016 Michael Garrison
C/o : San Rafael Police Association 1520 FiEch
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association, '. 12/:5/2016 Michael Garrison
c/o : San Rafael Police Association 1520 Fifch
Avenue
San Rafael , CA 94901
Union member's dues recelved through
intermediary: San Rafael police Association,
20 Fifth Av nue San R fael CA 4 01
12/29/2016 Michael Garrison
C/o : San Rafael Police Associacion 1520 Fifch
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
Ll a Gav lC
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Raf~el , CA 94901
Union member's dues received through
lnterm7diary : San Rafael Police Association,
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e ,g .. business enUty)
PTY -Political Party
SCC -Small Contributor Committee
IKJIND
DCOM
DOTH
DPTY
nscc
IKJ INO
OCOM
DOTH
OPTY
OSCC
~INO
DCOM
DOTH
DPTY
OSCC
~INO
DeOM
DOTH
OPTY
OSCC
IIDINO
DCOM
DOTH
OPTY
osee
Officer
City of San Rafael
Officer
City of San Rafael
officer
City of San Rafael
Officer
City of San Rafael
SUBTOTAL $
Statement cove rs period
rrom 09/25/2016
through _--=1=-2..:./--=3:..:1:.:./-=2:..:0-=1:..:6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page~ of 112
I.D.NUMBER
831S53
AMOUNT
RECEIVED THIS
PERIOD
CUM ULATIVETO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
16 .30 376 .20
16.30 376 .20
16.30 376 .20
81.50 1
FPPC Form 460 (JanI2D16)
FPPC Advice: advice@fppc.CC1.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRII3UTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
IIF SElf·EMPlOYED, ENTER NAME
OF BUSINESS)
~F CCloIMllTEE. Al.SOENrd< I,D NU!.46ER) CODE *
lO/2C/2C16 Lilah Gavlick
C/o: San Rafael Police Association 1520 <ifth
Avenue
San Rafael, CA 94901
Onion member's dues received through
intermediary: San Rafael Police Association,
1520 <ifth Avenue San Rafael CA 94901
11/CS/2016 Lilah Gavlick
11/15/2016
11/30/2016
C/o: San Rafael Police Association 1520 <ifth
Avenue
San Rafael, CA 94901
Union member's dues received through
interm~diary: San Rafael Police Association,
rifth
Fif~h
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Ra(ael Police Association,
1S20 Fifth Avenue, San Rafael, CA 94901
L~ a Gav J.C
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police A~~ociation,
. 1
9Conlributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g" business entity)
PTY -Polilica I Party
SCC -Small Contributor Committee
IR)INO
DeOM
DOTH
DpTY
DSCC
[glIND
DeOM
DOTH
OPTY
OSCC
IR]INO
oCOM
DOTH
OPTY
OSCC
IR]IND
DCOM
DOTH
OPTY
DSCC
[KlIND
DCOM
DOTH
OPTY
OSCC
Police Officer
City of San Rafael
Pol ice Off icer
City of San Rafael
Police Officer
City of San Rafael
Police Officer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
throu gh _....;1;;.;2;:.:/-=3-=1~/.::2..:.0.::.1.:..6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 45 of 112
I D.NUMBER
831:'~3
AMOUNT
RECEIVED THIS
PERIOD
CUMUl.ATIVETO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER EI.ECnON
TOCATE
(IF REQUIRED)
16.30 376.20
376.20
16.30 376.20
16.30 376.20
6_30 376 .20
81.50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
- - -_. -i' __ •• _ ~ ~ ~,_
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael police Association Political Action committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET AODRESS AND ZIP CODE OF CONTRIBUTOR CONTRI8UTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SElF·EMPLOYED. EN'~ NAME
OF 8UStNESS)
09/30/2016
10/20/2016
(If CCMMITTEE, ALSO ENTEA I D. NUMBER) CODE *
Fifth
Fifth
Fifth
Fifth
Fifth
IK]IND
OCOM
DOTH
OPTY
osce
!!lIND
oCOM
DOTH
D PTY
o see
~INO
DeOM
DOTH
oPTY
osee
~IND
oCOM
DOTH
oPTY
osce
IRJIND
DCOM
DOTH
D PTY
O SCC
Corporal
City of San Rafael
Corporal
City of San Rafael
City ot San Rafael
:City of San Rafael
SCHEDULEA (CONT.)
r-----SShta~~;m~e~n!t~co~v;.e~rs;rp;e~rl~o~d~--lI~ .. ~~"~
from ______ 09-'/....;2_S...:,/_2_0_l_6 ____ __
th ro ugh __ ....;1::..;2:.,,/...:.3:...:1"'/.,:2:.,:0;,::1;,::6'--__ _
AMOUNT
RECEIVED THIS
PERIOD
1
16.30
16.30
16.30
831553
CUMULATNETO DATE
CALENDAR YEAR
(JAN. 1 • DEC 31)
]76,20
376.20
376.20
PER ELECTION
TO DATE
(lr-REQUIRED)
SUBTOTAL $ B1.5 01
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e,g" business entity)
PTY -Political Party
SCC -Small Contributor Committee
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Association Political Action Committee
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIDUTOR CONTRIBUTOR
IIFCOMMITrEE. AlSO ENTER I 0 NVM~RI I CODE *
i
11/30/2016 Justin Graham
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member'S dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue S a n Rafael CA 94901
12/15/2C16 Justin Graham
C/o, San Rafael Police Association IS2e Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
12/29/2016 Justin Graham
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member'S dues received through
intermediary: San Rafael Police Association,
--:-."...,.:-:-..,."..,,....,...,:--1-:U2...0_E.·U.!..t'-~ a F 4 01
09/30/2016 Lori Hendricks
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94935
Union member'S dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
Lorl. Hen rl.C S
C/o: San Rafael Police Association 1520 Fifth
·Contributor eodes
IND -I ndividual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
see -Small Contributor Committee
94935
I
IXJIND
oeOM
DOTH
oPTY
OSCC
IXJINO
oeOM
DOTH
oPTY
osce
IXJINO
oeOM
DOTH
oPTY
oSCC
fiU INO
oeOM
DOTH
oPTY
OSCC
IXJINO
oeOM
DOTH
[JPTY
osce
IF AN INDNIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SElF· EMPLOYED. ENTER NAME
OF 8USWESS)
Corporal
City of San Rafael
Corporal
City of San Rafael
Corporal
City of San Rafael
~ispat:cher
City of San Rafael
Dl.spatc er
City of San Rafael
SU8TOTAL$
Statement COVE!~ period
from 09/25/2016
through _....:.1:..:2::..:/....:.3:.:1::..:/....:2:.:0:..:1:..:6" __
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page 47 of 112
I D NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUM ULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376,20
16.30 376.20
16.30 376.20
1.2.70 294,30
12.70 294.30
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAMEOFFILER
San Rafael Police Association Political Action Committee
DAlE
RECEIVED
FUll NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRI8UTOR
(IFCC~MI1TEE.ALSOENTERI.D.NUMB~RI CODE *
11 05 2016 Lori Hendn-eks [KJINO
C/o: San Rafael Police Association 1520 Fifth OX COM
Avenue
San Rafael, CA 94935 [] OTH
Union member's dues reeei vee through 0 PTY
intermediary: San Rafael Police Association, []SCC
1520 Fifth Avenue San Rafael LA 94901
11/15/2016 Lori Hendrick.s ~ IND
C/o: San Rafael Police Association 1520 Fifth DCOM
Avenue
San Rafael, LA 94935 DOTH
Union member's dues recei veci through 0 PTY
incermediary: San Rafael Police Associacion, OSCC
·F ~
11/]0/2016 Lori Hendricks !ilINO
C/o: San Rafael Police Association 1520 Fift::h DeOM
Avenue
San Rafael, CA 94935 DOTH
Union member's dues received through 0 PTY
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF· EMPLOYED. ENTER NAME
OF Il"US'NESS)
Dispatcher
City of San Rafael
Dispat:cher
City of San Rafael
Dispatcher
City of San Rafael
Statement covers period
from 09/25/2016
through 12/31/2016
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page 46 of 112
10. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTlON
TO DATE
(IF REQUIRED)
12.70 294.30
12.70 294.30
12.70 294.]0
intermediary: San Rafael Police Associacion, OSCC
. A ue, San Ra~l~~-24~0~1~ ____ ~ __________ -+~ __ ~~ ________________ +-________ ~~77+-________ ~~~~r-____________ __
12/15/2016 Lori Hendricks fX]INO Dispatcher 12.70 294.30
: C/o: San Rafael Police Association 1520 Fifth OX COM Cicy of San Rafael
Avenue
San Rafael, CA 94935 DOTH
Onion menlber' s dues rece i ved through 0 PTY
intermediary: San Rafael Police Association, []SCC
l~LO Fifth Avenue, San Rafael, CA 94901
12 29 2016 Lon. Hen n.c s !RI
C/o: San Rafael Police Association 1520 Fifth X INO
Avenue OCOM
San Rafael, CA 94935 DOTH
Union member's dues received through [] PTY
intermediary: San Rafael Police Association, (]SCC
·Contributor Codes
I NO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
D~spatc er
City of San Rafael
SUBTOTAL $
12.70 294.30
63.50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (8661275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to who Ie dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODe OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPLOYED. ENTER NAME
OF BUSINESS)
(IF COMMITTEE, AlSQ ENTER I 0 NUMBER I CODE *
09/30/2016 Robert Henkle
C/o : San Rafael police Associa~ion 1520 Fifth
Avenue
San Rafael, CA 94901
Union member 's dues received ~hrough
intermediary : San Rafael Police Association,
~77~~~--rlS20 Fifth Avenue San Rafael CA 4 01
10/20/2016 Robert Henkle
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
inte~diary, San Rafael Police Association,
-11/05/2016
11/15/2016
·Contributor Codes
IN D -Individual
COM -ReCipient Committee
(olher than PTY or seC)
OTH -Other (e .g .. business entity)
PTY -Political Party
sec -Small Contributor Committee
Fiftb
Fifth
Fifth
IR]IND
DeOM
DOTH
OPTY
Osee
OOINO
DeOM
D OTH
OPTY
osee
IXJIND
oeOM
DOTH
OPTY
osee
IKJIND
OGOM
DOTH
OPTY
osee
OOIND
oeOM
DOTH
UPTY
osee
Officer
City of San Rafael
Officer
City of San Rafael
officer
City of San Rafael
Officer
City of San Rafael
o J.cer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
~rough ~~1~2~/~3~1~/~2~0~1~6 ____ ___
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 4 9 of _..:.1.:..12=--
!.D. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATNETO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELEcnON
TO DATE
(IF REQUIRED)
16 .30 376 .20
16 .30 376.20
l6.JO 376.20
16.30 376 .20
16 .30 376 .20
81.50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FI LER
San Rafael Police Association Poli~ical Action Committee
Amounts may be rounded
to whole dolla rs.
DA.TE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAl. ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EI.!PLOYEO. ENTER Ni\.\.IE
OF BUSINESS)
(IFCOMMIITEE. ALSO ENTflH D. NUMBER) CODE *
12 15/2016 Robert Henkle
C/o ; san Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Associu~ion,
1520 Fifth Avenue San Rafael CA 94901
12/29/2016 Robert Henkle
09/30/2016
10/20/2016
C/o : San Rafael Police Association 1520 F~fth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
Avenue
San Rafael, CA 94901
Union member's dues received through
intennediary : San Rafael Pol :ce Association,
-.~~~~~~1~52~0~F~L~·fth Avenue, San Rafael, CA 94901
J . A exan er Ho m
C/o : San Rafael Pol~ce Association 1520 Fifth
Avenue
San Rafael, CA 94901
Onion member 's dues received through
intermediary: San Rafael Police Association,
'Contributor Codes
INO -IndiVidual
"'F
COM -Recipient Committee
(other than PTY or SeC)
OTH -Other (e.g .. business entity)
PTY -Political Party
SCC -Small Contributor Committee
IRJIND
DCOM
DOTH
DPTY
osee
IKJIND
DeOM
DOTH
DPTY
osec
!K)INO
DeOM
DOTH
DPTY
osee
~IND
DeOM
DOTH
DPTY
OSCC
IKIIND
DCOM
DOTH
OPTY
osee
Officer
City of San Rafael
Officer
City of San Rafael
Corporal
City of San Rafael
Corporal
City of San Rafael
Corpora
City of San Rafael
SUBTOTAL $
Statement covers peri ad
from 09/25/2016
~rough __ ~1~2~/~)~1~/~2~0~1~6 ____ ___
SCHEDULE A (CONT.)
CAL.IFORNIA 460
FORM
Page so of 112
1.0 . NUMBER
831 553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -OEC 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16 .30 3/6.:10
16 .30 376 .20
16 .30 3?6.20
16.30 316 .20
16.30 376 .20
81.50 1
FPPC Form 460 (JanJ2016)
FPPG Advice: advlce@fppc.ca.gov (866/275-3n2)
.. ---. ~ .... ---~ ---
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL . ENTER
OCCUPATION AND EMPLOYER
QF SELF-EMI"lOVEO. ENTER NAME
OFeusIN~
QF CC!!MmEE. ALSOENTEl'I 1.0 . NUMSER) CODE *
11 15 2016 J. Alexander Wolm
Ic/o: San Rafael police Association 1520 Fifth
Avenue
San Rafael, CA 9~901
Onion member's dues received through
intermediary : San RaEael Police Association,
1520 Fifth Avenue San Rafael CA 94901
11/)0/2016 J. Alexander Holm
C/o ; San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received th:ough
interm~diary; San Rafael ?olice Association,
12/15/2016
12/29/2016
09 3D 2016
·Contributor Codes
INO -Individual
COM -ReCipient Committee
(other than PTY or SCC)
OTH -Other (e .g., business entity)
PTY -Political Party
sec -Small Contributor Committee
Fifth
Fifth
Fifth
IRJINO
DCOM
DOTH
DPTY
osee
~INO
DCOM
DOTH
DPTY
oscc
!X}INO
DeOM
'lOTH
DPTY
oscc
IRJIND
oeOM
DOTH
DPTY
osec
IRJIND
DeOM
DOTH
OPTY
oscc
Corporal
City of San Rafael
Corpora l
City of San Rafael
Corporal
City of San Rafael
Corporal
City of San Rafael
Sergeant
City of San Rafael
SUBTOTAL $
Statement cOllers period
from 09/25/2016
through __ ~1~2~/~)~1~/~2~0~1~6~ __ ___
SCHEOULEA (CONT.)
CALIFORNIA 460
FORM
Page S1 of 112
1.0. NUMBER
831 55 3
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16 .30 376.20
16.30 376 .20
16 .30 376.20
16 .30 376.20
1 .30 ]76 .20
81 .50 1
FPPC Form 460 (Janf2016)
FPPC Advice: advice@fppc.cil.gDv (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Policical Accion Commi~tee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF· EMPLOYED, ENTER NAME
OF eusiNESS)
(IF COM MmeE. ALSO ENTER I D. NUM~ CODE *
10 20 2016
11/05/2016
11/15/2016
11/30/2016
12 15 2016
Lisa Holton
C/o : San Rafael police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael police Association ,
1520 Fifth Avenue San Rafael CA 94901
Lisa Holton
C/o : San Rafael Police Association 1520 Fifch
Avenue
San Rafael, CA 94901
Union member's dues recelved through
intermediary: San Rafael Police Association ,
I
Lisa Holton
C/o: San Rafael Police Association 1520 FiEth
Avenue
San Rafael, CA 94901
Union member's dues received chrough
intermediary: San Rafael Police Association,
. 1 4
Lisa Holton
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Kafael, CA 94901
Onion member's dues received through
intermediary : San Rafael Police Association ,
1520 Fifth Avenue, San Rafael, CA 94901
L~sa Ho ton
C/o: San Rafael Police Association 1520 fifth
Avenue
San aafael, CA 94901
Un ion member's dues received through
intermediary: san Rafael Police Association,
'Contributor Codes
INO -Individual
COM -Recipient Committee
(olher than PTY or SCC)
OTH -Other (e .g .. business entity)
PTY -Political Party
SCC -Small Contributor Committee
IX)INO
DCOM
DOTH
OPTY
OSCC
!!lIND
OCOM
DOTH
OPTY
osce
~IND
DeOM
DOTH
OPTY
osce
IRJIND
DeOM
DOTH
DPTY
osce
IRJIND
neOM
DOTH
OPTY
OSCC
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Sergeant
City of San Rafael
SUBTOTAL $
Statement covers period
hom 09/25/2016
through ___ 1~2~/~3~1~/~2~0~1~6 ____ ___
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page ___ 5_2_ of 112
1.0 . NUMBER
831 55 3
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
16 .30 376 .20
16.30 376.20
16.30 )76,20
16.30 376.20
81. 50 I
FPPC Form 460 (JanI2016)
FPPC Advic:e: advic:e@fppc.ciI.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(lfCOMMITTEE.AI..SOENTCR 1.0 NUMBER) CODE *
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOVER
(If SELF-EMPlOYED. ENTER NAME
OF BUS!NESS)
12/29/20'16-Lisa Holton
C/o : San Rafael Police Association 1520 Fifch
Avenue
San Rafael, CA 9i901
Un i on member's dues received chrough
intermediary: San Rafael Police A~sociation,
1520 Fifth Avenue San Rafael CA 9~901
09/30/2016 Kyle Hornste i n
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Associat~on,
10/20/2016 Kyle Hornstein
C/o: San Rafael Police Associacion 1520 Fifth
Avenue
San Rafael, CA 94901
Union men~er's dues received through
intermediary: San Rafael Police ASsociacion,
1 20 Fifth Av nue S n R 1
11/05/2016 Kyle Hornstein
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
1ntenmediary : San Rafael police Association,
1520 F1fth Avenue San Rafael, CA 94901
Ky e HornBte~n
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 9i901
Union member's dues received through
intermediary: San Rafael Police Association,
·Contributor Codes
IND -Individual
COM -Recipient Committee
(other than PTY or SeC)
OTH -Other (e .g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
!&lIND
DCOM
DOTH
DpTY
DSCC
~IND
DCOM
DOTH
DPTY
DSCC
OOIND
DeOM
DOTH
DPTY
Dsce
!&lIND
DCOM
DOTH
DPTY
osee
!&lIND
DeOM
DOTH
DPTY
DSCC
Sergeant
City of San Rafael
Corporal
City of San Rafael
Corporal
City of San Rafael
Corporal
City of San Rafael
Corpora_
City of San Rafael
SUBTOTALS
Statement covers period
from 09/25/2016
tnrou gh _....:1:..::2;.:../..::.3.::.1'-'/2::..;0:..:1:...:6'---__
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR VEAR
(JAN 1 -DEC. 31)
PER EI.ECnON
TO DATE
(IF REOUIRED)
16.30 3 76 .20
16 .30 376 .20
16.30 376 .20
16.30 376.20
16.30 376.20
81.50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police ASsociacion Policical Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STIlEET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED. ENTER NAME
(IF COMMInEE. ALSOENTCR I D NUMBER) CODe *
'n
Rafael Police Associacion 1520 Fifth
Fifth
Fifth
Fifth
Fifth
OOIND
DeOM
DOTH
oPTY
osee
!K)IND
oeoM
DOTH
oPTY
osee
IX)IND
OCOM
DOTH
npTY
osee
®IND
DCOM
DOTH
oPTY
nscc
!K)IND
DCOM
nOTH
OPTY
oscc
OF BUSlNESS)
Cicy of San Rafael
Sergeant
City of San Rafael
City of San Rafael
SCHEDULE A (CONT.)
~--~SSi~~tee,m~enrrt~c;o~v~e~~sop;eririoodd----lI~II"~~~
from 09/25/2016
through _....;1;;.;2;;.:/....;3;..:1:..:./..:2;..:0..:1..:6 __ _ Page __ ~ of 112
AMOUNT
RECEIVED THIS
PERIOD
16 ,)0
16.30
16.30
1.0 NUMBER
B31553
CUMULATIVE TO DATE
CAlENDAR YEAR
(JAN. 1 . DEC. 31)
376,20
376.20
376 .20
PER ELEcnON
TO DATE
(IF REQUIRED)
SUBTOTAL $
·Contributor Codes
IND -Individual
eOM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
see -Small Contributor Committee
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca .gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Associa~ion Policical Accion Comm~ttee
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
~FCCMMlnEE. ~50ENTER 1.0 NUMBER) CODE *
'Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e .g .. business entrty)
PTY -Political Party
SCC-Small ContributorCommittee
!!lIND
DCOM
DOTH
OPTY
Osee
I!lIND
DCOM
DOTH
DPTY
DSCC
IKJIND
DCOM
DOTH
OPTY
osce
~fND
oCOM
DOTH
OPTY
OSCC
\RlIND
DCOM
DOTH
DPTY
DSCC
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF· EMPLOYED. ENTER NAME
Of BUSINESS)
City of San Rafael
Sergeant:
City of San Rafael
Sergeant
City of san Rafael
Sergeanc
City of San Rafael
ty of San Rafael
SUBTOTAL $
Statement covers peri od
SCHEDULEA (CO NT.)
-~WII!!~'"
from __ ----.:co~9!.../;;:.2;;:.S'-/2=_O=_1::.;6=__ __ _
through _---'1:..:2:..</--'):..:1:.!./-=2:.:0~1:.:::6 __ _
AMOUNT
RECEIVED THIS
PERIOD
16.30
16.30
81. 50 I
B31553
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
376.20
376.20
PER ELECTION
TOOATE
(IF REQUIRED)
FPPC Fonn 460 (JanJ2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Association policical Ac~ion Committee
DATE
RECENED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRI8UTOR CONTRISUTOR
{IF COUMrT lEE, I\L.SO ENTER 1.0 NUMBeR) CODE ...
09 )0/2016 Daisy Huerta iR]IND
C/o: San Rafael Police Association 1520 Fifch
Avenue DeOM
San Rafael, CA 9'1901 DOTH
union member' 5 dues received through 0 PTY
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
Ilf SELF· EMPLOYED. ENTER NI\UE
OF BUSINESS)
Call Taker Records
specialist
Cicy Of San Rafael
Statement covers period
from 09/25/2016
through __ ~12~/~)~1~/~2~0~1~6 ____ ___
SCHEDULEA (CONT.)
CALIFORNIA 460
FORM
Page 56 of 112
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULAnVE TO OATE
CALENDAR YEAR
(JAN 1· DEC . 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12.70 134..10
intermediary: San Rafael Police Associacion, [JSCC
1520 Fifth Avenue San~R~a~f~a£e:l~CA~~9~4~9~0~l~ ____ -+~~ ______ ~~ ____ ~ ________________ ~ ______ --~~~r---------~~~~----
09/]0/2016 Scott Ingels IRJINO Corporal 16.30 376.20
C/o: San Rafael Police Association 1520 Fifch DCOM City of San Rafael
Avenue
San Rafael, CA 9'1901 DOTH
Union mEmber's dues received through 0 PTY
intermed~ary: San Rafael Police Associacion, []See
10/20/2016
Fifth
11/05/2016
Fifth
11 15 2016
Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermed1ary: San Rafael Police Association,
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other Ihan PTY or SCC)
OTH -Olher (e.g., business enlily)
PTY -Polilical Party
SCC -Small Contributor Committee
IXJIND
DeOM
DOTH
DPTY
osee
IKJINO
DCOM
DOTH
[JPTY
[Jsee
IKIIND
DCOM
DOTH
DPTY
[]SCC
Corporal
City of San Rafael
Corporal
City of San Rafael
Corpora
City of San Rafael
SUBTOTAL $
16,30 376.20
16.30 376.20
16.30 376. 0
77.9°1
FPPC Form 460 (Janl2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Association Political Action committee
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
IIF COI.IMmEE.ALSO€NTER I 0 , NU~BSR) CODE *
11/30/2016 Scott Ingels I&JINO
C/o; San Rafael Police ASllociat':'on 1520 Fifth oeOM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
~F SELF·EMPlOYEO. ENTER NAME
OF BUSINIOSSI
Corporal
City of San Rafael
SCHEDULE A (CaNT.)
Statemen t c-;;ov~e~rs;-;;;;:~I-'II!!IIIIIIII!!!I1!11~'"
from 09/25/2016
th rough __ 1_2....:/_3_1-,/_2....;0,-,-1....;6 __ _
AMOUNT
RECEIVED THIS
PERIOD
16.30
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN, 1 -DEC. 31)
376 .20
_---"-'--of 112
PER ELECTION
TO DATE
(IF REQUIRED)
intermediary, San Rafael Police Associacion, DSCC
~~~~~~~15~2~n,.Fifth Avenue, San Rafael. c~. ~9~4~9~0~1 ___ ~-=~ ___ ~ ____ ~~ _________ -+ _____ ~~~ _______ ~~~~ ______________ _
12/15/2016 SCOl:\.: Ingels IRJIND Corporal 16 .)0 376.20
C/o; San Rafael Police Association 1521) Fifth oCOM City of San Rafael
Avenue
San Rafael, CA 94.901 DOTH
Onion member' s dues rece i ved th1:"ough 0 PTY
intermediary; San Rafael Police ASsociation, osee
1520 Fifth Ayenue San Rafael. C8
12/29/2016 Scott Ingels !XJIND
C/o ; san Rafael Police Association 1520 Fifth oCOM
Avenue
San Rafael, CA 94.901 DOTH
Union member' s dues received t!1rough 0 PTY
intermeciiary: San Rafael Police ASsociation, []SCC
2 -' Avenue, San Rafael CA 9490.
09/30/2016 Rebecca Jensen fKllND
c/o San Rafael Police Association 1520 Fifth X
Avenue DCOM
San RaEael. CA 94901 DOTH
union member's due s rece i ved through 0 PTY
intermediary: San Rafael Police Association, osee
1520 Fitch Avenue, San Rafael, CA 94901
Re ecca Jensen lRJ
c/o San Rafael Police Association 1520 Fifth INO
Avenue DCOM
San Rafael, CA 94901 DOTH
union member's due6 received througb OPTY
incerm7~iary: San Rafael Police Association, osee
'Contfibutor Codes
IND -Individual
COM -Recipient Committee
(other than PTY or SeC)
OTH -Other (e.g ., business entity)
PTY -Political Party
sec -Small Contributor Committee
Corporal
Cicy of San Rafael
Records Clerk
City of San Rafael
Recor s C ex-k
City of San Rafael
SUBTOTAL $
16.30 376.20
12.70 294.30
12.70 294.30
FPPC Form 460 (Janl2016)
FPPC Advice: advice@fppc.ca,gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
Statement covers period
from 09/25/2016
th rough __ 1 __ 2,-,/....:3:....;1....:./_2....:0_1....:6 __ _
SCHEOULE A (CONT)
CALIFORNIA 460
FORM
Page_--=.;58~ of 112
I.D.NUMBER
831553
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRlaUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF S8..F·EMPLQY8). ENTER NAME
OFBUSItlESS)
AMOUr-rr
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TODATF (IF COMMrrTEE. ALSOEtliE'll 0 NUMBER) CODE *
(IF REQUIRED)
1l/05/2016
1l/15/20lli
11/JO/2016
Rebecca Jensen
c/o San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary; San Rafael Police Association,
1520 Fi fth Avenue San Rafael CA 94901
Rebecca Jensen
c/o San Rafael police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
.~
12/15/2016 Rebecca Jensen
c/o San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union lOellwe:::-' s dues received through
intermedia:::-y: San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
Re ecca Jensen
c/o San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
'Contributor Codes
INO -Individual
1:' •.
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e .g ., business entity)
PTY -Political Party
SCC -Small Contributor Committee
OOINO o COM
DOTH
DPTY
osec
~IND
DCOM
DOTH
DPTY
osce
Records Clerk
City of San Rafael
Records Clerk
City of San Rafael
12.70 294.30
12 .70 294.30
----~~--~~~~--------~--------~~~--------~~~~---------------IXJIND Records Clerk 12 .70 291.30
DeOM City of san Rafael
DOTH
DPTY
osec
lRJlND
DCOM
Don~
LJPTY
osee
~INO
DCOM
DOTH
DpTY
osee
Records Clerk
City of San Rafael
Recor s
City of
SU8TOTAL$
12.70 294.30
12.70 294,30
6].50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (8661275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Associacion Poli~ical Ac~ion Committee
Amounts may be rounded
to whole dollars.
Statement covers period
from 09/2S/2G15
through ___ l_2~/_3_1~/_2_0_1_6 ____ ___
seHEDULEA (CONT.)
CALIFORNIA 460
FORM
Page 59 of_..:1.:.12::....-
1.0 NUMBER
831553
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER AMOUNT CUMULATIVETO DATE
OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR
PER ELECTION
TO DATE (IF COMt.fIITEE. AlSO ENTER I D. NUMB9l) CODE *
(IF SElF-EMPI.OYEO. E/IlTER NAME PERIOD (JAN, 1 -DEC . 31) (IF REQUIRED)
09 30/2016 Rebecca Kuga
C/o: San Rafael Police Associacion 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues recelved through
in~ermediary , San Rafael Police Associacion,
-:-::-7::-:-~:-:-::--~15,,;2~O,,-FiJth Avenue, San Raesel, CA 94901
10/20/2016 Rebecca Kuga
C/o, San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary . San Rafael Police Association,
11/05/2016'
11/15/2016
·Contributor Codes
INO -Individual
. F
eOM -Recipient Committee
(other than PTY or seC)
OTH -Other (e .g ., business entity)
PTY -Political Party
sec -Small Contributor Committee
Fifch
Fifth
Fifth
!RJ IND
DeOM
LJOTH
DPTY
Dsee
OFB~IN~~ ______ ~ __________ ~-=~ __________ ~~~4-________________ _
YS8 Supervisor 12.70 294._30
City of San Rafael
----~~~~--~--------------4_--------~~~4_----------~~~I-------------------!RlIND YSBSupervisor 12.70 294.30
DeOM City of San Rafael
DOTH
DPTY
osee
IKIINO
oeOM
DOTH
OPTY
oscc
IKJIND
oeOM
DOTH
OPTY
osee
!RJIND
DeOM
DOTH
LJPTY
osee
'iSS Supervisor
City of San Rafael
YSB Supervisor
City of San Rafael
YSB Superv].sor
City of San Rafael
SUBTOTAL $
12,70 294 .30
12.70 294. .30
12.70 294 .30
63.50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/27S-ln2)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SEIJ'..EMPLOYCD. ENTER NAME
OF BUSINESS)
(lFCOIo.4MITI(E.ALSOENTERI.D NUMBER) CODE ...
12/15/201 6' 'Rebecca I<uga
C/o: San Rafael Police Association 1520 Fif~h
Avenue
San Rafael, CA 94901
Union member's dues received through
incermediary: San Rafael Police Association,
1520 Fifth Avenue San Ra fael CA 94901
12/29/2016 Rebecca Kuga
C/o: San Rafael Police Association 1520 Fif~h
Avenue
San Rafael, CA 94901
Un~on member's dues received through
interm7diary: San Rafael Police Association,
09/30/2016 Marc Laplante
C/o, San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association.
. ve e an Rafael CA 4 01
10/20/2016 Marc Laplante
C/o: San Rafael Police Associa~ion 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
~~~~~~~1~520 Fifth Avenue. San Rafael, CA 94901
11/05/2016 Marc 'Lap ante
C/o: San Rafael Police Association 1520 fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
~ntermediary : San Rafael Police Assoc ia~ion.
'Contributor Codes
INO -Individual
COM -Recipient Committee
(olher than PTY or SCC)
OTH -Other (e.g " business entity)
PTY -Political Party
see -Small Contributor Committee
!!lIND
DeOM
DOTH
DPTY
DSCC
[RlIND
DeOM
DOTH
DPTY
oscc
OOIND
DCOM
DOTH
DPTY
Dsce
!&:lIND
OCOM
DOTH
DPTY
osee
IK)IND
DCOM
DOTH
[JPTY
osce
YSB Supervisor
City of San Rafael
Y'SB Supervisor
City of San Rafael
officer
Ci~y of San Rafael
officer
City of San Rafael
o lcer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
through ___ l~2~/~3~1~/~2~0~1~6~ __ ___
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page _-"..:60~ of 112
I.D.NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 • DEC, 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12 .70 294 .30
12 .70 294 ,30
16 .30 376,20
16.30 376 ,20
16.30 37 .20
FPPC Fonn 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAMEOF FILER
San Rafael Police Association Political Accion Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMP!.OYl::D. ENTER NAME
OF BU5!NESS)
(IF COMMIns:. ALSO ENTER 10 NUMBER) CODe *
11/15/2016 Marc Laplante
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received chrough
intermediary : San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
11jJO 2016 Marc Laplante
C/o; San Rafael Police ASsociation 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
12/15/2016
12/29/2016
·Contributor Codes
IND -Individual
. 1.
COM -Recipienl Committee
(other than PTY or SCC)
OTH -Olher (e.g ., bUSiness entity)
PTY -Polihcal Party
SCC -Small Contributor Committee
Fifth
Fifth
,ifth
IKJIND
DCOM
DOTH
OPTY
OSCC
IKJIND
DCOM
DOTH
npTY
osee
IXlIND
DCOM
DOTH
DPTY
OSCC
!X]IND
DeOM
UOTH
DPTY
osce
[RJIND
DeOM
DOTH
DPTY
DSCC
Officer
Cicy of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Statement covers period
from 09/25/20lG
through _-'1;;.;2;:.;/-'3-'1:..:/...:2:...;0;.:1:...;6'--__
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page_~61~ of 112
1.0. NUMBER
B31~~3
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 • DEC. J1)
PER ELECTION
TO DATE
(IF REQUIRED)
16,)0 ]76.20
16 .30 376.20
16.30 376.20
16.30 376 .20
FPPC Form 460 (JanJ2016)
FPPC Advice: advice@fppc.ca .gov (866/27S·3n2)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Association Political Action Committee
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IF COMMInEe. ALSOEfolTER I,D, NUM~) CODE *
10/20/2016 Anndora Le e IRJIND
oCOM
DOTH
oPTY
osee
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intennediary: San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
11/05/2:016 Annciora Lee IRJIND
oeOM
DOTH
oPTY
osec
C/o: San Rafael Police Association 1520 Fifth
11/15/2016
Fifth lXJlND
oCOM
DOTH
oPTY
osee
11/)0/2016 Anndora Lee !K)IND
C/o: San Rafael Police Association 1520 Fifth DCOM
Avenue
Sao Rafael, CA 94901 DOTH
Union member's dues received through [J PTY
intermed~ary: San Rafael police Association, [JSCC
1520 Fifth Avenue, San Rafael CA 94901
Ann ora Lee IKl N
C/o: San Rafael Police Association 1520 Fifth X I D
Ave:lue oCOM
San Rafael, CA 94901 DOTH
Onion member's dues received through 0 PTY
IF AN INDIVIDUAL, ENTER
OCCUPATION ANO EMPLOYER
(IFSELF·EM~lOYEO. ~NTER NAt.4E
OF BliSlNESSJ
Dispatcher
City of San Rafael
Oispatcher
City of San Rafael
Dispatcher
City of San Rafael
Dispatcher
City of San Rafael
Ol.Spatc er
City of San Rafael
Statement covers period
from 09/25/2016
th rough __ 1_2-,/_3_1..,:./_2_0_1_6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 62 of 112
I,D,NUMBER
83155)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO OATE
CALENDAR YEAR
(JAN. 1 • DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12.70 294.]0
12.70 294,)0
12.7 0 294.]0
12.70 294.)0
12.70 294,)0
intermediary, San Rafael Police Association, [JSCC
v Sag Rafael, CA 94~DJ============================================~==============~~===============================;
63.50 1
'Contributor Codes
IND -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g .. business entity)
PTY -Political Party
see -Small Contributor Committee
SUBTOTALS
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (B66/275-3n2)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FUU NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPLOYED. t:::NTER NIIME
OF BUSINESS)
IIFCOMM!TTEE. ALSO ENn:R to. NUMBERI COOE •
12 29 2016 Anndora Lee
C/o: San Rafael police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues t"eceived through
intermediary; San Rafael Police Association,
1520 fifth Avenue San Rafael CA 94901
09/30/2016 Judy Lee
10/20/2016
11/05/2016
C/o : San RaEael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Onion member's dues received through
interm7diary: San Rafael Police Association,
Fifth
Fifth
Avenue
San Rafael , CA 94901
Onion member's dues ceceived thcougb
intermediary : San Rafael Police Association,
1520 .itth Avenue , San Rafael, CA 94901
11 lS 2016 Judy Lee
C/o: San Rafael Police ~sociation 1520 Fifth
Avenue
San Rafael, CA 94901
union member's dues received through
intermediary: San Rafael Police Association,
'Contribulor Codes
IND -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e .g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
OOIND
oCOM
DOTH
oPTY
oscc
OOIND
oCOM
DOTH
oPTY
OSCC
@IND
DCOM
DOTH
OPTY
osec
iKllND
DeOM
DOTH
DPTY
osee
!!lIND
DCOM
DOTH
OPTY
osce
Disoatcher
City of San Rafael
Records Specialist
Ci~y of San Rafael
Recot"cis Specialist
City of San Rafael
Records Specialist
City of San Rafael
Recor
Ci ty of
SUBTOTAL $
Statement covers period
~om 09/25/2016
through ___ 1~2~/~3~1~/_2_0_1_6 ____ ___
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page _-",-63,,--of 112
I.D.NUMBER
B3lSS3
AMOUNT
RECEIVED THIS
PERIOD
CUMULATNETO DATE
CALENDAR YEAR
(JAN . 1 . DEC . 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12.70 294 .30
12 .70 294 .)0
12.70 294.30
12.70 294.30
2 .70 294 .30
63.50 1
FPPC Form 460 (JanJ2016)
FPPC Advice: advlce@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Folice Associacion Political Action Committee
DATE
RECE(VED
11/30 2016
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IF COMMITTEE. ALSO Etm;.R 1.0 NUM8ER) CODE *
Judy Lee OOIND
C/o : San Rafael Folice Association 1520 Fifth
J\venue DCOM
San Rafael, CA 94901 DOTH
Union member' s dues received through 0 PTY
iotermediary: San Rafael Police Association, Osee
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
~F SELF·EMPLOYED, ENTER NAME
OF BUS1N~SS)
Records Specialisc
City of San Rafael
Statement covers period
from 09/25/2016
throug h _....:1:..:2"-,/....:3:..:1::.:./-.:2:..:0....:1,,,6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 64 of _..::.1.:..12=---
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12.70 294.30
1520 Fifth Avenue San Rafael CA 94901 12/1S/~2~O~1~6~~J~U~d~Y~L~e~e~~~~~~~~~~~~~~~~----~-~IN-D----~~R~e-c-o-r~d-s-S~p-e-~-~~·a~l~i~s~t------~r-----~1~2~.~7~0~--------~2~94~.3~O~------------------
C/o: San Rafael Police Association 1520 Fifth DeOM City of San Rafael
Avenue
San Rafael, CA 94901 DOTH
Union member' s dues rece i ved through 0 PTY
:.nterm7diary: San Rafael Police Association, osee
12/29/2016
09/30/2016
10 20 2016
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or seC)
OTH -Other (e,g .• business entity)
PTY -POlitical Party
see -Small Contributor eommiL1ee
Fifth
FiEch
Fitch
!K)IND
oeOM
DOTH
DPTY
LJsee
IK]IND
DeOM
DOTH
DPTY
Dsce
!!lIND
oeOM
nOTH
DPTY
usce
Records Specialist
City of San Rafael
Sergeant
City of San Rafael
Sergeant
City of San Rafael
SUBTOTAL $
12.70 294.30
16.30 376.20
16.30 376.20
FPPC Form 460 (Jan/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts milY be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRI8UTOR IF AN INDIVIDUAl, ENTER
OCCUPATION AND EMPLOYER
[IF SELF,EMPLOYEO, ENTEl'I NAME
OF BUSINESS)
(IFCCIoIMInEE. ALSO ENTER 1.0 . NUMBER) CODE *
11 OS/2016 Rogelio Leon
C/o : San Rafael Police Association 1520 Fifth
Avenue
,San Rafael, CA 9~901
. union member's dues received through
intermediary: San Rafael Police Association,
--=-::-;-:=-=-=-=-=-=--+~1",,5..!C2.>!.0;"F~.i. fth Avenue San Rafael CA 4 01
11/15/2016 Rogelio Leon
C/o: Sa~ Rafae~ police Association 1520 Fifth
Avenue
san Rafael, CA 94901
Union member's dues received through
lnterm7diary: San Rafael Police Association,
11/30/2016 Rogelio Leon
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 9~901
Union member's dues received through
intermediary: San Rafael Police Association,
-2 , '. Avenue, San Rafael, CA 949Q'
12/15/2016 Rogelio Leon
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
union member's dues received through
i ntermediary : San Rafael Police Association,
1520 Fifth Avenue, San Rafael , CA 94901
12 29 20 1 6 Roge lO ~eon
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 9~901
Union member's dues received through
interm7diary : San Rafael Police Association,
·Conlribulor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e .g " business entity)
PTY -Polilica I Party
SCC -Small Contributor Committee
I&)IND
DCOM
DOTH
DPTY
osec
..
[RJINO
DCOM
DOTH
oPTY
OSCC
IRJIND
oCOM
DOTH
OPT'(
OSCC
IKIIND
DCOM
DOTH
OPTY
OSCC
OOIND
OCOM
DOTH
OPTY
oscc
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Sergeant
Cicy of San Rafael
Sergeant
City of San Rafael
Sergeant
City of San Rafael
SU8TOTAL$
Statement covers perl od
from __ O ~/2S/2016
~rough_~1~2~/~J~1~/~2~0~1~6 __ ___
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page _....:::;65:::...-of 112
I.IJ. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 • DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
15 .30 376,20
16.30 376.20
16 ,JO 375 .20
16,)0 376.20
16,]0 376.20
81.50 1
FPPC Form 460 (Jiln/2CJ16)
FPPC Advice: advice@fppc.ca ,gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Association Political Action Committee
DATE
RECEIVEO
FULL NAME. STREET ADDRESS AND ZIP COOE OF CONTRIBUTOR CONTRIBUTOR
~FCCMMlnEE.ALSOENn:R 1.0 NUMBER) CODE *
09 30/2016 Kevin Macdougald IflIND
C/o: San Rafael Police Association 1520 Fifth DeOM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
intermediary : San Rafael Police Association, []SCC
1520 Fifth Avenue San Rafael CA 94901
10/20/2016 Kevin Macdougald @IND
C/o: San Rafael Police Association 1520 Fifth DeOM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
intermediary: San Rafael Police Association, osce
11/05/2016 Kevin Macdougald (KlIND
C/o: San Rafael Police Association 1520 Fifth OCOM
Avenue
San Rafael. CA 94901 DOTH
Union member's dues received through 0 PTY
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF S8.F-EMPi.OYEO. ENTER NAME
OF BUSINESS)
Officer
City of San Rafael
officer
City of San Rafael
Officer
City of San Rafael
Statement covers period
~om 09/25/2016
through __ ~1~2~/~1~1~/~2_0~1~6 ____ ___
SCHEDULE A (CONT)
CALIFORNIA 460
FORM
Page 66 of_~1~12~
1.0. NUMBER
831553
AMOUNT
RE.CEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
376.20
16.30 376 .20
16.30 376.20
intermediary: San Rafael Police Association, OSCC
IS20 Fift ~ __ ~4~0~1 ______ -+ __________ ~~~ ______________________ r-________ ~~~~ __________ ~~~~ ________________ ___
11/15/2016 Kevin Macdougald IRlIND Officer 16.30 J 76.20
C/o: San Rafael Police Association 1520 Fitth OX COM City of San R.afael
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
intermediary : San Rafael Pol~ce Association, OSCC
1520 Fifth Avenue, san~~R~a~f~a~e~l~,~C~A~_9~4~9~0~1~ ______ r-__________ ~,~~~ ______________ ----4-----------,,~~----------~~~~-------------------
1 3 2016 Kev~n Mac ouga .. ' !R)INO at ~cer 16.30 376.20
c/o: San RaEael Police Association 1520 Fifth X City of San Rafael
Avenue DCOM
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
~n~er;ediary: San Rafael Police Association, i]SCC
·Contributor Codes
INO -Individual
COM -ReCipient Committee
(other than PTY or seC)
OTH -Other (e.g .. business entity)
PTY -Political Party
SCC -Small Contributor Committee
SUBTOTAL $ 81. SO I
FPPC Fonn 460 (Jan/2016)
FPPC Advice: advic:e@fppc .ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Pol i ce AesociaLion Political Ac~ion Committee
DATE
RECENED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(W COM MmEE, Al.SO ENTER I.D. NUMBER> CODE"
12/15/2016 . Kevin Macdougald !R]INO
C/o: San Rafael Police Association 1520 Fifth DCOM
Avenue
San Rafael, CA 94901 DOTH
Union member' s dues recei ved through U PTY
IF AN INDIVlDUAL. ENTER
OCCU PATION AND EMPLOYER
~F SELf·EMPLOYEO. ENTER NA"-lE
OF SUS'NCSS)
Officer
City of San Rafael
intermediary: San Rafael Police Association , osee
-:-.".-.,.:::-=--r=-:::-::-c:--l--t:-1""52,,,o F i f th Avenue, San Ra f ael , CA 94 ~O.l~ __ -+--:=-___ +-,...,...,,..,....,. _____ _
12/29/2016 Kevin Macdougald IRJIND Officer
C/o: San Rafael Police Association 1520 Fifth DeOM City of San Rafael
Avenue
San Rafael, CA 9t,.901 DOTH
Union member's dues received r.hrough DPTY
intermediary: San Rafael Police Association, osee
09/3 0/2016
10/20/2016
11 05 2016
·Contributor Codes
INO -Individual
COM -Recipient Commiltee
(other than PTY or SCC)
OTH -Other (e.g., bUS iness entity)
PTY -Political Party
see -Small Contributor Committee
Fifth
Fifth
Fifth
IKlIND
DCOM
DOTH
oPTY
osce
!KlINO
DeOM
DOTH
oPTY
oSCC
!KlINO
DeOM
DOTH
OPTY
DSCC
Officer
City of San Rafael
Officer
City of San Rafael
o l.cer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2~n_6 ___ _
throug h _--=1:.:2:.!/-=3:.:1:.!./-=2:.:0-=1..::6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page_~67~ of 112
1.0. NUMBER
831553
AMOUNT
RECE IVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
H .30 376.20
16 .30 376.20
16.30 376.20
16.)0 376 .20
16.30 )76.20
81. 50 I
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275 -Jn2)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCU PATION AND EMPLOYER
pF SELF·~P1.0YEO. ENTER NAME
OF BUSINCSSJ
(If COM MmEE. ALSO ENTER I,D. NUMBER)
11/15/2016 Carlos Maldonado
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1 520 Fifth Avenue San Rafael CA 94901
11/30/2016 Carlos Maldonado
12/15/2016
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
inte~ediary, San Rafael Police Association,
"F d
Fifth
12/29/2016 Carlos Maldonado
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermed~ury: San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
Ml.c ae Mat 1S
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
·Contributor Codes
IND -Individual
iJL.~ fth Ayeoll
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
see -Small Contributor Committee
CODE *
!&lIND
DCOM
l]OTH
npTY
osce
!&lIND
OCOM
DOTH
OPTY
OSCC
IKIIND
OCOM
nOTH
OPTY
OSCC
!&lIND
DCOM
DOTH
OPTY
osce
IKJIND
OCOM
[lOTH
OPTY
OSCC
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Corpora
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2 016
~rough __ ~1~2~/~3~1~/~2~0~1~6~ __ ___
SCHEDULEA (CONT.)
CALIFORNIA 460
FORM
Page _.....:::.6B=---of 112
LD.NUMBER
8315S3
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376_20
16.30 376.20
16_30 376.20
16.30 376.20
16.30 376.20
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (8661275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION ANO EMPLOYER
(IF 5 ELF· EMPLOYED, ENTel NAME
OF BUSINESS)
(IFCO.l!MmEE,AtSOENl1:RI.O NUMBER) CODE *
10/20/2016' Michael Math~s
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary; Sen Rafeel Police Association,
1520 Fifth Avenue San Rafael CA 94901
11/05/2016 Michael Mathia
C/o; San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Pal1ce Association,
11/15/2016
11/30/2016
·Contributor Codes
IND-Individual
COM -Recipient Committee
(other than PTY or SeC)
OTH -Other (e .g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
Fifth
Fi[ch
Fifth
®IND
DCOM
OO-rn
DPTY
oSCC
~IND
DCOM
DOTH
DPTY
osee
Ii]IND
DCOM
DOTH
DPTY
osee
IRJIND
DCOM
DOTH
OPTY
osce
OOIND
DCOM
DOTH
oPTY
osee
Corporal
City of San Rafael
Corporal
City of San Rafael
Corporal
City of San Rafael
Corporal
City of San Rafael
Coroora
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
~rough ___ l_2~/_3_1~/~2~0~1~6 ____ ___
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page 69 of 112
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC . 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
16 .30 376.20
16.30 376.20
16.30 376,20
16.30 37 .20
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FilER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
rUll NAME, STREET ADDRESS AND ZIP CODE OF CONTRfBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
IIF S€LF·EMPi.OVEO. ENTl:R NAME
OF BUSINfSS)
(IFCOMMITIEE.ALSOENTERID NUMBeR) CODe ..
12/29/2016 Michael -Mathis
C/o; San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Onion member's dues received through
intermediary: San Rafael Police Association,
1 20 Fifth Avenue San Rafael CA 94901
09/30/2016 Kelly Mauel
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Onion member's dues received through
intermediary: San Rafael Police Association,
10/20/2016
Fifth
11/05/2016
Fifth
Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
·Contributor Codes
INO-Individual
eOM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
see -Small Contributor Committee
IK)INO
DeOM
DOTH
DPTY
osee
I8)INO
oeOM
DOTH
oPTY
osce
IXJIND
oeOM
DOTH
DPTY
osee
IXJIND
DeOM
DOTH
oPTY
oscc
IRJINO
oCOM
DOTH
OPTY
osec
Corporal
City of San Rafael
Communications Dispatcher
City of San Rafael
Communications Dispatcher
City of San Rafael
Communications Dispatcher
City of San Rafael
Commun1.catl.ons Dl.Spatc er
Cicy of San Rafael
SUBTOTALS
Statement covers period
ITom 09/25/2016
th ra ugh __ 1"-2::..:/:....:3:....:1'-'./:....:2:....:0,,,1:..=6 __ _
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page _---'-70:0....-of 112
. io. NUMBER
831~~]
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 • DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
12 .70 294.30
12.70 294.30
12.70 294.30
12.70 294 .30
FPPC Form 460 (Janl2D16)
FPPC Advice: advice@fppc.ca.gov (866/275,3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Po1ice Association ?olitical Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECENED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRISUTOR IF AN INDNIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF· EMPLOYED. ENTEFI NAIo!E
OF 8(JSINES$)
(IF CCMMITIEE. ALSO ENTER 10 NUMBI;:I1) CODe ...
11 30 2016 Kelly Mauel
C/o, San Rafae l Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary· San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94 01
12/15/2016 Kelly Mauel
c/o, San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
union member's dues received through
intermediary· San Rafael Police ASsociation,
12/29nOl6
09/30{2016
10/20 /20 16
·Contributor Codes
IND-lndividual
COM -RecipJent Committee
(other than PTY or SeC)
OTH -Other (e .g., business entity)
PTY -Polilical Party
SCC -Small Contributor Committee
Fift:h
Fifth
Fifth
1KI1ND
OCOM
DOTH
oPTY
OSCC
(KJIND
DCOM
LJOTH
oPTY
oSCC
~IND
DCOM
DOTH
oPTY
OSCC
IKJIND
DCOM
DOTH
OPTY
DSCC
IKJIND
OCOM
DOTH
OPTY
osee
Communica~ions Dispatcher
City of San Rafael
Communications Oisoatcher
City of San Rafael"
Communicat:ions Dispatcher.
City of San Rafael
Officer
City of San Rafael
O,_lcer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
through _....;1:..;2:..:/....;3:..:1,-,/..:2;.:0;.::1;.::6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 71 of 112
I.D.NUMBER
831553
AMOUNT
RECENED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 " DEC . 31)
PER ElECnON
TO DATE
(IF REQUIRED)
12.70 294.30
12.70 294.30
12.70 294.30
16.30 J76.20
16 .30 3 76 .20
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS ANO ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF· EMPLOYED. ENTER NAME
OF eUSINESS)
(IrCOMMJTTEE.AlSOEIflCRIO NUMBER) CODE ...
11/05/2016 Phillip Melodia
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
11/15/2016 Phillip Melodia
C/o: San Rafael Police Association 1520 Fifth
Avenue
Sao Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
12/15/2016
·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
Fifth
F'ifch
Fifth
/KlIND
OCOM
DOTH
OPTY
OSCC
OOIND
oCOM
DOTH
OPTY
OSCC
[KJIND
OCOM
DOTH
OPTY
OSCC
IKJIND
OCOM
nOTH
OPTY
OSCC
IK)IND
OCOM
DOTH
OPTY
oscc
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
o l.cer
City of San Rafael
SUBTOTALS
Statement covers period
from 09/25/2016
through ~_1_2..;./~3~1...:./_2_0_1_6_~_
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page ____ 72;;... of 112
1.0 NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC . 31)
PER ELECTION
TOCATE
(IF REQUIRED)
16.30 376 .20
16.30 376.20
16,30 376.:20
16.30 376.20
16,)0 376,20
81. 50 I
FPPC Form 460 (Jan/2016)
FPPC Advice: adv!ce@fppc.ca.gov (8661275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FUll NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
~F S8..F·EMPLQVEO. ENTER NAME
OF BUSINESS)
<,F COMM'ITEE. ALSO ENTER 10 NLlMGER) CODE *
09 3D 2016 Beth Minka
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 9490,
Union member's dues received through
intermediary: San Rafael Police ASsociation ,
1520 Fifth Avenue San Rafael CA 94901
10/20/2016 Beth Minka
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Associat i on,
11/05/2016
Fifth
11/15/2016
FiEch
Fifrh
Avenue
San Rafael, CA 94901
Union member's dues received through
incerm~diary, San Rafael Police Association,
·Contributor Codes
INO-Indivldual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e .g ., business entity)
PTY -Political Party
SCC -Small Contributor Commit1ee
IR]IND
DCOM
DOTH
DPTY
OSCC
IRJIND
DCOM
DOTH
OPTY
oscc
~IND
oeOM
DOTH
OPTY
OSCC
~IND
DCOM
DOTH
OPTY
OSCC
IKJIND
DCOM
DOTH
DPTY
DSCC
Ad ministrative Technician
City of San Rafael
Administracive Technician
City of San Rafael
Administrative Techn1cian
City of San Rafael
Administrative Technician
City of San Rafael
A m~n1stratlve Tec lC}an
City of San Rafael
SUBTOTAL $
St9tement covers period
from 09/25/2016
~rough __ ~1~2~/~3~1~/~2~O~1~6 ____ ___
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 7) of 1.12
I.D.NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC . 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12.70 294.30
12.70 294.)0
12 .70 294.30
12.70 294.30
12 .70 294 .30
63.5°1
FPPC Form 460 (Jan/2016)
FPPC Advice: adv1ce@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Folitical Action Committee
Amounts may be rounded
to whole dolla rs.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRI8UTOR CONTRIBUTOR
(1I'"CCMMlnEE.ALSOEIIT£RI .O NUMBER I CODE .,
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELf-EMPLOYEO. ENTCR NAt.!E
OFIltISINESS)
12 15/2016 Beth Minka
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
inte rm e diary: San Rafael Police Aseociation,
1520 Fif th Avenue San Rafael CA 94901
12/29/2016 Be th Minka
09/30/2016
10/20/2016
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
interm7diary: San Rafael Police Association,
Fifth
Fifth
Avenue
San Rafael, CA 94901
union member's dues received through
intermediary : San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
11/05/2016 Lynn Murp y
C/o: San Rafael ~olice Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Raf.a~1 Police Association,
'Contributor Codes
INO -Individual
COM-RedpientCommittee
(other than PTY or seC)
OTH -Other (e.g., business entity)
PTY -Political Party
see -Small Contributor Committee
\!JIND
DCOM
DOTH
OPTY
osee
~IND
DCOM
UOTH
OPTY
osee
IKJINO
DCOM
LJOTH
OPTY
osee
/iJIND
DCOM
DOTH
DPTY
Dsce
IKJIND
DeOM
DOTH
DPTY
osec
Administrative Technician
City of San Rafael
Administracive Technician
City of San Rafael
Menta l Health Outreach
Provider
City of San Rafael
Mental Health Outreach
Provider
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
through __ ~1~2~/~3~1~/~2~0~1~6~ __ ___
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page _---'-74=__ of 112
I.D.NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN 1 -DEC . 31)
PER ELECTION
TO DATE
<IF REQUIRED)
12 .70 294.30
12.70 294 .30
12.70 294.30
12 .70 294 .30
1 2.70 2 4,30
63.50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772,
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police ASsociacion Political Accion Comm~ttee
Amounts may be rounded
to whole dolla rs .
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR I" AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
<IF SElJ'-EMPlOVEO. ENTER NAME
OF BUSINESS)
(IF COMMmEE.ALSO EtHER I D_NUMBER) CODE *
11/15/2016 Lynn Murphy
C/o : San Rafael Police Association 1520 Fifth
}l.venue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael police Association ,
~~~~~~~1~5~20~F~i=Ch Avenue San Rafael CA 94901
11/30/2016 Lynn MUL~hy
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
12/15/2016
12/29/2016
09 30 2016
·Contributor Codes
INO -Individual
'r.
eOM -Recipient Committee
(other than P1Y or SCC)
OTH -Other (e,g,. business entity)
PTY -Political Party
SCC -Small Contributor Committee
Fifth
Fifth
Fifth
IK)IND
OCOM
UOTH
OPTY
oscc
IKJIND
DCOM
UOTH
ljPTY
oscc
~IND
OCOM
DOTH
OPTY
osce
!RJIND
OCOM
DOTH
DPTY
osce
lKIlND
DCOM
DOTH
DPTY
OSCC
Mental ~ealth Outreach
Provider
City of San Rafael
Mental Health Outreach
Provider
City of San Rafael
Mental Health Oucreach
Provider
City of San Rafael
Mental Health Outreach
Provider
City of San Rafael
SUBTOTALS
Statement covers period
trom 09/25/2016
through ___ 1~2~/~J~1~/~2~0~1~6 ____ ___
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 75 of~
1.0,NUMBER
831553
AMOUNT
RECENED THIS
PERIOD
CUMULA1WETO DATE
CALENDAR YEAR
(JAN. 1 -DEC, 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12.70 294.30
12 _70 294.30
12.70 294.30
12.70 294,30
12.70 294,]
63 .50 1
FPPC Form 460 (Janf2016)
FPPC Advice: advice@fppc.ca.gov (886/27S-3n2)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Comm i ttee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND liP CODE OF CONTRIBUTOR CONTRIBUTOR
(IF COMMITTEE. ALSO ENTEllI 0 NUMB€R) CODE *
IF AN INDIVIDUAL , ENTER
OCCUPATION AND EMPLOVER
(IF SELF·EMPLOYEO . ENTER NAt..1E
OF BUSINESS)
: 0 20/2016 Jorge Navarro
C/o: San Rafael Police Association 1S20 Fifth
Avenu e
San Rafael , CA 94901
Un i on member's dues received through
intermedia ry : San Rafael Police Association,
1520 Fifth Ave nue San Rafael CA 94901
11/05/2016 Jorge Navarro
11/1 5 /2016
C/o: San Raf ael police Association 1520 Fi fth
Avenue
San Rafael, CA 94901
Union member's dues received through
i nterm~diary: San Rafael Police Association,
Fifth
11/30/2016 Jorge Navarro
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Unlon member's dues received through
intermediary : San Rafael Police Association ,
1520 Fifth Avenue , San Rafael, CA 94901
12 15 2016 Jor ge Navarro
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermedi ary: San Ra fae l Poli ce Association,
·Contributor Codes
INO -Individual
COM -Recipient Committ.ee
(other than PTY or SCC)
OTH -Other (e .g., bus iness entity)
PTY -Political Party
see -Small Contributor Committee
OO IND
oeOM
DOTH o PlY
OSCC
IEJINO
OeOM
D OTH o PlY
OSCC
IX]IND
DeOM
D OTH
O P1Y
DSCC
IK)INO
DCOM
DOTH o PlY
osee
IRJIND
oCOM
DOTH
oPTY
oSCC
Evidence Technician
Ci ty of San Rafael
Ev i d ence Technician
City of San Rafael
Evidence Techni cian
City of San Rafael
Evidence Techni cian
City of San Rafael
SUBTOTAL $
Statement covers period
hom 09/25/2016
llirough __ ~1~2~/_3~1~/~2~0~1~6 ____ ___
SCHEDULEA (CONT.)
CAL.IFORNIA 460
FORM
Page 76 of 112
1.0 NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVe TO DATE
CALENDAR VEAR
(JAN. 1 -DEC . 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12.70 294 .30
12.70 2 94 .30
12.70 294 .30
12 .70 294.30
12.70 29 4 ,30
63.50 1
FPPC Form 460 (JanJ2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Associa~ion Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION ANO EMPLOYER
IIF SElf-EMPLOYEO, ENTER NAM€
OF BUS4NESSI
(If CCMMIITEE.AlSO ENTER 1.0. NUMBER) CODE ...
12 29 2016 Jorge Navarro
C/o : San Rafael police Association 1520 Fifch
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police ASsociacion,
1520 Fifth Avenue San Rafael CA 94901
C9/.30/2016 Alexis Nielsen
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police ASsocia~ion, _.....,...-----, __ -+ ........ 0 .
10/20/2016 Alexis Nielsen
C/o : San Rafael Police Association lS2C Fifth
Avenue
San Rafael, CA 94902
Union member's dues received through
intermediary: San Rafael Police ASsocia~ion,
1520 ift 4
11/05/2016 Alexis Nielsen
C/o; San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received th~Ou9h
intermediary: San Rafael Police Ascociation,
1520 FiEth Avenue, San Rafael, CA 94901
11 15 2016 A_eXiS I'lle sen
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Ra:~el, CA 94901
Un i on member's dues received through
~ntermediary: San Rafael Police AssociatiOQ,
'Contributor Codes
INO -I ndividual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e,g .. business entity)
PTY -Political Party
SCC -Small Contributor Committee
IK]IND
oeOM
DOTH
OPTY
osec
[gJIND
oeOM
DOTH
DPTY
osec
~IND
oeOM
DOTH
OPTY
osec
~IND
DCOM
DOTH
DPTY
oscc
!KIIND
DeOM
DOTH
UPTY
USCC
Ev~dence Technician
City of San Rafael
Lead Communications
Dispatcher
City of San Ratae!
Lead Communications
Dispa.tcher
City of San Rafael
Lead Communications
Dispatcher
City of San Rafael
Lea Commun~cationE
Dispatcher
City of San Rafael
SUBTOTALS
Statement covers period
from 09/25/2016
th ro ugh _...:1;.:2;.:../~3.:.1 /:....;2:..:0:..:1;.:6~ __
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 77 of _...:1~1:.;2~
I.D.NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVETO DATE
CALENDAR YEAR
(JAN 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12 .70 294.30
12 .70 294.30
12,70 294.30
12.70 " 294.30
12.70 294.30
63 .50 1
FPPC Form 460 (JanJ2016)
FPPC Advice: advice@fppc.ca.goll (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action committee
Amounts may be rounded
to whole dollilrs.
DATE I FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRI8UTOR
RECEIVED ! (IFCOMMITTEi:.ALSOENTEJHD NUMB~R) CODE"
IF AN INDIVIDUAL. ENTER
OCCUPATiON AND EMPLOYER
(IF sar·EMPlOYED. ENTfll NAME
OF BUSINESS)
11/30/2016 Alexis Nielsen
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
12/15/2016 Alexis Nielsen
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
12/29/2016
09/30/2016
fo
·Contributor Codes
INO -Individual
COM -Recipienl Committee
(other than PTY or SeC)
OTH -Other (e.g .. business entity)
PTY -Political Party
SCC -Small Contributor Committee
Fifth
FJ.fth
Fifth
~INO
oeOM
DOTH
OPTY
osec
[hlINO
DeOM
DOTH
OPTY
osee
~INO
D COM
DOTH
OPTY
osee
~INO
DeOM
DOTH
OPTY
osee
~INO
DeOM
UOTH
OPTY
osec
Lead Communications
Dispatcher
City of San Rafael
Lead Commun i cations
Dispatcher
City of San Rafael
Lead Communications
Dispatcher
City of San Rafael
Officer
City of San Rafael
o }.cer
City of San Rafael
SUBTOTAL $
Statemenf covers period
from 09/25/2016
through ___ 1~2~/~3~1~/~2~O~1~6~ __ ___
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 78 of.........!..U
I.D.NUMBER
anSS3
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 • DEC . 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12.70 294 .30
12 .70 294 .30
12.70 294 .30
16,30 376.20
16 .30 376 .20
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866f275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRlBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF S£Lf·EMP!.OYEO. ENTER NAME
OF IlIJSINESSI
(IFCow.~Irn:e.ALSOENTER 10 NUMeER) CODE.
11/05 2016 Leslie O'Toole
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : Sao Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
11 15/2016 Leslie O'Toole
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Un~on member's dues received through
intermediary: Sao Rafael Police Association,
--:-11:-/"'"'3:-0""'/'"'2'"'0-:-16'" t~~L~j g~ Toole
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fif A 4 I
12/15/2016 Leslie O'Toole
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael. CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
Les l.e O'TOO e
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael. CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
·Contributor Codes
INO -Individual
'F 4
COM -Recipient Commitlee
(other than Pll' or seC)
OTH -Other (e.g., business entity)
?TV -Political Party
SCC -Small Contributor Committee
OOIND
oCOM
DOTH
oPTY
osee
IZ]INO o COM
DOTH
OPTY
nsce
~IND
oeOM
DOTH
OPTY
osee
~IND
oeOM
DOTH
UPTY
osce
OOI ND
DeOM
DOTH
OPTY
osce
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
o l.cer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/:25/2016
throu gh _....:1:..:2:..:/..::3:..:1~/.=2.::.0.::.1 =..6 __ _
SCHEOULEA (CaNT.)
CALIFORNIA 460
FORM
Page 79 of 112
/.D. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 -DEC . 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16 .30 376 .20
16.30 376 .2 0
16.30 376.20
16 .301 376.20
1 .30 376,20
81. 50 I
FPPC Form 460 (JanI2016)
FPPC Advice : advice@fppc .ca.gov (B661275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Associa~ion Policical Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCU PATION AND EMPLOYER
(IF SELF .. EM~lOYEO. ENTER NAME
01' BUSINESS)
(lfCOW..ImEE.ALSOENTERI,I),NUMBER) CODE *
09/30/2016 Sr"J .. an Patterson
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, LA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
IKJIND
DeOM
DOTH
OPn'
osee
Officer
City of San Rafael
Statement cOllers period
from 09/25/2016
through __ 1_2....:/_3_1...:./_2...;.0_1_6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 80 of 112
I.D,NUMBER
831553
AMOUNT
RECEIVED TAIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 • DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376 ,20
~77~~~~~15~2~0~F~if~h Avenue San Rafael CA 4901
10/20/2016 Brian PaLLerson ----~~~----------------~--------~~~--------~~~~---------------IK)IND Officer 16.30 376.20
C/O! San Rafael Police Association 1520 Fifth
Avenue
San Rafael, LA 94901
Union member's dues received through
interm7diary: San Rafael Police Association,
11/05/2016
11/15/2016
11 30 2016
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SeC)
OTH -Other (e .g .. business entity)
PTY -Political Party
sec -Small Contributor Committee
Fifth
Fifth
Fifth
DCOM City of San Rafael
DOTH
OPn'
o see
IXJ IND
D eOM
DOTH
DPiY
OSCC
IKIIND
D COM
DOTH
OPTY
osee
OOIND
oeOM
DOTH
OPTY
osce
Offi cer
City of San Rafael
Officer
City of San Rafael
o l.cer
City of San Rafael
SUBTOTAL $
16,)0 376.20
16.30 376.20
16.30 76.20
81. 501
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (8661275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael ~olice Association Political Action Committee
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IFCCMMmEE.ALSQ£NTERI.O NUMBER) CODE ...
12/1-5/2016 Bnan Patterson IK]IND
C/o: San Rafael police ASsociation 1520 Fifth DCOM
Avenue
San Rafael, CA 94901 LJ OTH
Union member' s dues received through 0 PTY
intermediary: San Rafael Poll.ce Association, o sec
1520 Fifth Avenue San Rafael CA 94901
12/29/2016 8rian Patterson IRIIND
C/o, San Rafael Police ASsociation 1520 Fifth oCOM
"venue
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SEU'·EMPLOY€O. ENTER NAME
OF SUSINESS)
Officer
City of San Rafael
Officer
City of San Rafael
intermediary: San Rafael Police Association, osec
~079~/3~0~/~2~0~1~6~~BU~f~fY~P~'axs~o~yeoue, -~il-~~~~~~~~-------r--~--IN-O----~-O~£~f-i-ce--r-----
C/o: San Rafael Police ASsociation 1520 Fifth U" COM City of San Rafael
Avenue
San Rafael, CA 94901 DOTH
union member's dues received chrough 0 PTY
intermediary: San Rafael Police Association, OSCC
o h Av e, San Rafael 0
10/20/2016 Buffy Paxson IRJINO
C/o: San Rafael Police ASSociation 1520 Fifth OX COM
"venue
San Rafael, CA 94901 DOTH
Union member' s dues received through 0 PTY
incermediary : San Rafael Police Association, OSCC
1520 Fifth Avenue, San Rafael CA 94901
11 OS 2016 Bu,:~y Paxson IRJINO
C/o: San Rafael police ASsociation 1520 Fifth X ~~ o~
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
inte~ediary: San Rafael Police Association, osce
'Contribulor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entily)
PTY -Political Party
SCC -Small Contributor Committee
Officer
City of San Rafael
o ).cer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
~rough __ ~1~2~/~3 ~1~/2~0~1~6 ____ __
SCHEDULEA (CaNT.)
CALIFORNIA 460
FORM
Page 81 of 112
I.D.NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULAnVETO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIREO)
16 .30 376.20
16 .30 376.20
16.30 376.20
16 .30 376.20
16 .30 376.20
81 .50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advlce@fppc.ca.gov (8661275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Association political Action Committee
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
~FCCMlIAllTEE .ALSOENTERI.O NU!.ISERI CODE *
11/15/2016 Buffy Paxson [KJIND
C/o: San Rafael Police Association 1520 Fifth
Avenue DCOM
San Rafael, CA 94901 DOTH
union member's dues received through 0 PTY
intermediary: San Rafael Police Association, osec
IF AN INDIVIDUAL, FNTER
OCCUPATION AND EMPLOYER
(If sar.ELlPlOYEO. ENTER NAME
OF BUSINESS)
Officer
Cicy of San Rafael
1 20 Fifth Avenue San R~a~f~a=e~l~CA~~9~4~9~O~1~ ____ -+~~ ______ ~
11/)0/2016 BuHy Paxson .. ' ~IND Officer
C/o: San Rafael Police Association 1520 Fifth oeOM City of San Rafael
Avenue
San RafaeL CA 94.901 DOTH
Union member's dues received through oPTY
intermediary: San Rafael Police Association, oSCC
12/15/2016 Buffy Paxson OOINO
C/o, San Rafael Police Associal:ion 1520 Fl fth 0 COM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received through 0 PTY
incermediary, San Rafael Police Association, osec
15 . a a 1 4 01
12/29/2016 Buffy Paxson ~IND
C/o : San Ratael ~olice Associatlon 1520 Fifth X
Avenue oeOM
San Rafael, CA 94901 DOTH
union member's dues rece~ved through LJPTY
inl:ermediary, San Rafael Police Association, OSCC
~n7"",.,,~~~1~52~0~Fifth Avenue, San Rafael, CA 94.901
09 30 2016 JeSS.1Ca · Perry [KJ
C/o: San Rafael Police ASsociation 1520 Fifch X INO
Avenue DCOM
San Rafael, CA 94901 DOTH
Onion member's dues received through D PTY
inte~ediary : San Rafael Police Association, osee
·Contributor eodes
INO -Individual
COM -Recipient Committee
(other than PTY or SeC)
OTH -Other (e.g., business entity)
PTY -Political Party
see -Small Contributor Committee
Officer
City of San Rafael
Officer
City of San Rafael
o leer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
through 12/ 31 ~.O 1:..:6'--__
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 82 of 112
1.0 . NUMBER
a)1~~3
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 . DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376 .20
16.30 376 .20
16.30 376.20
16.30 316 ,20
16 .30 37 .20
81.5°1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FUl.L NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF S ELF-EMPlOYED. eNTER NAME
OF BUSINESS)
(IF CCMMlnEE. ALSO ENTER I 0 NUMBER) CODE *
10 20 2016 Jessica Perry
C/o: San Rafael Police Associacion 1520 Fifth
Avenue
San Rafael, CA 94901
Onion member's dues received through
intermediary: San Rafael Jolice Association,
1520 Fifth Avenue San Rafael CA 94901
11/05/2016 Jessica Perry
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
inte~diary: San Rafael Police Association,
11/15/2016 Jessica Perry
c/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenu RaE el CA 4 01
11/30/2016 Jessica perry
C/o; San Rafael Police Association 1520 Fif~h
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
12 15 2016 Jess:lca Perry
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
, 2JL.~ . .fth AyeDll~
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
IRJIND
DCOM
DOTH
DPTY
oscc
IKJIND
DCOM
DOTH
DPTY
DSCC
I.K]IND
DCOM
DOTH
DPTY
DSCC
I.K]INO
DCOM
DOTH
DPTY
DSCC
!;KlINO
DCOM
DOTH
OPTY
OSCC
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of san Rafael
officer
City of San Rafael
O!_lCer
City of San Rafael
SUBTOTALS
Statement covers period
~om 09/25/2016
throug h __ 1_2-'./_3_1-'./_2_o_1_6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 83 of_-=1.=;12=--
I.D.NUMBER
631553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. J1)
PER ELEcnON
TO DATE
(IF REQUIRED)
16.:;0 376.20
16.30 376.20
16.30 376.20
16,30 376.20
16.30 376.20
81. 50 I
FPPC Form 460 (JanJ2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Associa~ion Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS ANO ZIP COOE OF CONTRIBUTOR CONTRIBUTOR IF AN INOIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
IIF SEl.F·EM?I.OYEO. ENTEl NAMe
Of8USINESS)
(IFCCMMIrn::E,AlSOENTalIO NUMBel)
12 29/2016 Jessica Perry
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael , CA 94901
Union member 's dues received through
in~ermediary : San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
09/30/2016 Aaron !?iombo
:D/20/2016
-:11 / 0 5 / 2 0 16
C/o: San Rafael Police Association 1520 Fifch
Avenue
San Rafael, CA 94901
Union member 's dues received through
intermediary; Sa~ Rafael Police Association,
Fifth
Fifth
Avenue
San Rafael , CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
1520 Fifth Avenue San Rafael , CA 94901
11 15 2016 Aaron p~o 0
C/o: San Ra:ael Pol i ce Association 1520 Fifth
Avenue
San Rafael, CA 94901
UnioD member's dues r e ceived through
intermediary : San Rafael Police Association,
'Contributor Codes
IND -Individual
i
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g .. business entity)
PTY -Political Party
sec -Small Conlribulor Committee
CODE ...
OOIND
DeOM
DOTH
DPTY
osee
IKJ!ND
DeOM
DOTH
DPTY
osee
OOIND
DeOM
DOTH
OPTY
osee
IK)IND
oeOM
DOTH
DPTY
osee
IKJIND
DCOM
DOTH
OPTY
o see
Officer
City of San Rafael
Police Corporal
City of San Rafael
Police Corporal
City of San Rafael
Police Corporal
City of San Rafael
Po 1ce Corpora
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
th rough __ 1_2....:/_3_1...:./_2_0_1_6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 84 of 112
LD .NUMBER
83155 3
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 -DEC. 31)
PERELEcnON
TO DATE
(IF REQUIRED)
16 .30 376.20
16 . )0 376 .20
16.30 376.20
16. JO 376.20
16.30 376.20
81.50 1
FPPC Form 460 (JanI2016)
FPPC Advice : advice@fppc.ca .gov (866/275..:3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODe OF CONTRIBUTOR CONTRIBUTOR
(Ir-COMMmEE, ALSO ENTER 1.0 NUM6...."R) CODE ...
SCHEDULE A (CONT.)
Statement covers period
from 09/25/2016
CALIFORNIA 460
FORM
th rough _....;;1;.;:2~/=-):;:.:1 /:....:2:...:0:..::;1:..::;6 __ _ Page as of 112
I.D.NUMBER
AMOUNT
RECEIVED THIS
PERIOD
8J1SSJ
CUMULAnvETO DATE
CALENDAR YEAR
(JAN . 1 -DEC. 31)
PER ELECTION
TOOATE
<'F REQUIRED)
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
III' SE\.f·Et.4PlOYED, ENTER NAME
OF BUSINESS)
~11~)~0~2~0~1~6~~A~a-r-o-n~p~i~o-mbo'-----------------------------------~-~--'N-D-----4~P~O·l~iC~e~C~o~rp~ora'1~--------1---------~1~6~.~J~0+---------~J~7~6~.2~0~------------------
C/o: San Rafael Police Association 1520 Fifth Cicy of San Rafael
Avenue DeOM
San Rafael, CA 94901 DOTH
Union member's dues received t:hrough 0 PTY
intermediary: San Rafael Police Association, OSCC
1520 Fifth Avenue San Rafael CA 94901
12/15 /2 0 1 6 Aaron <'iombo @IND
C/o: San Rafael Police Association 1520 Fifth DeOM
Avenue
San Rafael, CA 94901 DOTH
union member's dues received through 0 PTY
intermediary : San Rafael Police Association, osee
12/29/2016 Aaron Piombo IlJIND
C/o: San Rafael police Association 1520 Fifth DCOM
Avenue
San Rafael, CA 94901 DOTH
Union member':!l dues received through 0 P"n'
intermediary: San Rafael Police Association, osee
-::"":""7::-:--;-:"""C::":""""C:--1-"J,22 0 'f h Ave nan Ra f a 1 4 0 1
09/30/2016 Allyson Powell IKIIND
C/o: San Rafael Police Association 1520 Fifch X
·Contributor Codes
I NO - I ndivid ual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
P"n' -Political Party
sec -Small Contributor Committee
Fitch
oCOM
DOTH
oPTY
osee
@IND
DeOM
DOTH
OPTY
osce
Police Corporal
Cicy of San Rafael
Police Corporal
City of San Rafael
Communications Dispatcher
City of San Rafael
Communlcatlons Dlspatc er
City of San Rafael
SUBTOTAL $
16 .)0 376 .20
16 .30 376 .20
12 .70 294.30
12 .70 294.30
.=o=J
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (8661275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Association Political Action Committee
DATI'
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONmlBUTOR
(l~coM>.\mEe.ALsoENTERI.D.NIft.lBERI CODE *
IF AN INDIVIDUAL. ENTER
OCC UPATION AND EMPLOYER
(IF SELF·EMPI.OYEO. ENTER NAME
Of BUSINESS)
~1~1~0~5'/2~0~1~6--t7A'1'ly-s~o~n~p~o~w-e~l~l~------------------------------+--UO-IN-D---r.C~o-m-m~un~i~c~ations Dispatcher
C/o : San Rafael Police Association 1520 Fifth City of San Rafael
Avenue DCOM
San Rafael. CA 94901 DOTH
Union member's dues received through 0 PTY
i~termediary: San Rafael Police Association, OSCC
1~20 Fifth Avenue San Rafael CA 94901
11/15/2016 Allyson Powell UOINO
C/o : San Rafael Police Association 1520 Fifth OCOM
Avenue
San Rafael. CA 94901 DOTH
Union member's dues received through OPTY
interm7diary: San Rafael police Association, OSCC
11/30/2016
Fifth
12/15/2016 Allyson Powell
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
-'~~T-'-~~~lr52~0~F~ifth Avenue, San Rafael, CA 94901
A yson Powell'-
c/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
lnte~diary: San Rafael police ASsociation,
·Contributor Codes
INO-Individual
COM -Recipient Committee
(other than PlY or seC)
OTH -Other (e .g ., business entity)
PTY -Political Party
SCC -Small Contlibutor Committee
~IND
oCOM
DOTH
oPTY
osce
IKJIND
OCOM
DOTH
DpTY
osce
!!lIND
DCOM
DOTH
OPTY
osee
Communications Dispatcher
City of San Rafael
communications OisDatcher
City of San Rafael-
Communications Dispatcher
City of San Rafael
Communlcatlons Dlspatc er
City of San Rafael
SUBTOTAL $
Statement cOllers period
from 09/25/2016
throug h _....;1;:.:2:..:/....;3;..:1:-'./...::2;..:0..::1;..:6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page_~86~ of 112
1.0. NUMBER
831553
AMOUNT
RECENED THIS
PERIOD
CUMULA1WETO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(tF REQUIRED)
12.70 294.30
12 .70 294 .30
12.70 294.30
12.70 294.30
12.70 294.30
63.50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Associacion Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECElVED
FULL NAME. STREET ADDRESS AND Z.IP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPLOYEe. ENTCR NAME
OF BUSINESS)
(IF COMMITTEE, ALSO ENTEA I 0 NUMBER) CODE *
09/30/2016 Dennis Prince
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Unioo member 's dues received through
intermediary : San Rafael Police Associ ation,
15 2 0 F ifth Avenue San Rafael LA 94901
10/20/2016 Dennis Prince
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
interm~diary, San Rafael Police Association,
11/05/2016
11
·Contribulor Codes
INO -Individual
COM -Recipient Committee
(ether than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Commil1ee
Fitch
Fi fth
Fifth
~IND
DeOM
DOTH
DPTY
Dsec
OO IND
DeOM
D OTH
DPTY
osee
lKIlNO
D eoM
DOTH
DPTY
DSCC
OOIND
DeoM
DOTH
D PTY
Dsec
OOIND
DeoM
DOTH
O PTY
DSCC
Offi cer
City of San Rafael
Off icer
City of Sa n Rafael
Officer
City of San Rafael
Officer
City of San Rafael
o i cer
City of San Rafael
SU8TOTAL$
Statement covers period
from 0 9 /25/2016
through _....:1:;.:2::..!/....:):..:1~/-=2:.:0:.:1-=6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 87 of _ 112
1.0 . NUMBER
8)1553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVETO DATE
CALENDAR YEAR
(JAN . 1 -DEC . 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16 ,)0 376 .20
16 .30 376.2 0
16.30 3 76.20 .
16.30 376.20
6 .30 376 .20
B1. SO I
FPPC Form 460 (Jan/2016)
FPPC Advice: ildvlce@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action committee
Amounts may be rounded
to whole do liars.
DATE
RECEIVED
FULL NAME , STREET ADDRESS AND liP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
~F SElf-EMPLOYED, E/IffER NAME
OFB~NESSI
~FCO"'MrnEE.ALSOE"'1EI'!ID NUMBERI COOE .,
12/15/2016--Dennis Prince
C/o : San Rafael Police Association 1520 Fifch
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 F i fth Avenue San Rafael CA 91901
12/29/2016 Dennis Prince
09/30/2016
10/20/2016
C/o : San Rafael Pol i ce Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermedi ary: San Rafael Police Association,
Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
1520 Fifth Avenue , San Rafael, CA 94901
1 1 05 2016 Glno Rantlssl
c/o San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
interm7d~ary : San Rafael Police Association,
'Contributor Codes
IND -Individual
COM -Recipient Committee
(other than PTY or SCC)
On-I -Other (e ,g., business entity)
PTY -Political Party
SCC -Small Contributor Committe e
OOINO
DCOM
Dom
OPTY
osce
!KlIND
DeOM
DOTH
DPTY
osee
IIIIND
DeOM
DOTH
OPn'
osee
[KlIND
DeOM
DOTH
OP1Y
osee
[KlIND
DCOM
DOTH
OP1Y
osee
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
o ).cer
Cicy of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
through _-'1;;..;.2"'-/..;;.3..;;;1.;../..;.2-'-01;.:..6'--__
SCHEDULE A (CONT)
CALIFORNIA 460
FORM
Page BB of_..!.1~12:::...-
1.0. NUMBER
B31SS3
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC 31)
PER ELECTJON
TO DATE
(IF REQUIRED)
16.30 376.20
16.30 376 .20
16 .30 376.20
16.30 376,20
16 .3 0 376.20
81.50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc,ca.gov (8661275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPLCM::D, ENTER NAME
(IFCOMIAITTEE. ALSO ENTER I 0 NUM8EI11 CODE *
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PlY or SCC)
OTH -Other (e .g ., business entity)
PTY -Political Party
SCC -Small Conlributor Committee
Police Association 1520 Fifth
94901
Fifth
IKIIND
DCOM
DOTH
oPTY
osec
IKlIND
DeOM
DOTH oPTY
osec
IKJIND
oeOM
DOTH o PlY
USCC
IKIIND
oeOM
DOTH
oPTY
osee
IK)IND
oeOM
nOTH o PlY
osee
OF BUSINESSI
San Rafael
City of san Rafael
SUBTOTAL$
Statement covers period
SCHEDULEA (CONT.)
"'-'!IIIIIIP~""
from __ --=-0 9,-,1,-,2:..;:5,-,-1-=2....:.0-=2..:..6 __ _
throug h __ 1_2-,-1_3_2..:./_2_0_1_6 __ _
AMOUNT
RECEIVED THIS
PERIOD
16 .
16 .30
16.30
16.30
81,50 1
831553
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC . 31)
376 .20
376 .20
376.20
376.20
PER ELECTION
TO DATE
(IF REQUIRED)
FPPC Form 460 (Jan/2016)
FPPC Advice : advice@fppc.ca .gov (B66/27S-3n2)
~ - -1 _-_. ___ •• _
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL . ENTER
OCCUPATION AND EMPLOYER
IIF SELf·EMPLOVEO. ENTER NAME or SUSINESS)
~FCCMMlnEE.ALSOENrERI .o .NuMeER) CODE *
10/20/2016 Ronda Reeee
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1!>20 Fifth Avcaue San Rafael CA 94901
11/05/2016 Ronda Reese
11/l.5/2016
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Associatlon,
. 1
Fifch
11/30/2016 Ronda Reese
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary, San Rafael Police Association,
1520 Fifch Avenue, San Rafael, CA 94901
Ron a Reese
C/o: San Rafael Police Association 1520 Firth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Pollce Association,
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g .. business entity)
PTY -Political Party
SCC -Small Contributor Committee
OOIND
DCOM
DOTH
DPTY
osce
OOIND
D COM
DOTH
OPTY
osce
~IND
DeoM
DOTH
DPTY
OSCC
IXJIND
DCOM
DO~
DPTY
osec
OOIND
DCOM
DOTH
DPTY
OSCC
Corporal
City of San Rafael
Corporal
City of San Rafael
Corporal
City of San Rafael
Corporal
City of San Rafael
Corpora
City of San Rafael
SUBTOTAL $
Stateme nt covers perf ad
from 09/25/20)6
through __ ~1~2~/~3~1~/~2~0~1~6~ __ ___
SCHEDULEA (CaNT.)
CALIFORNIA 460
FORM
Page _.....::..90,,--of 112
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATNETO DATE
CALENDAR YEAR
(JAN . 1 • DEC. 31)
PER ELECTION
TOOATE
(IF REQUIRED)
16.30 376 .20
16 .30 )"16 .20
l.6.30 )"16 .20
16.30 3"16.20
16.30 3"16 .20
81. 50 I
FPPC Form 461l (JanJ21l16)
FPPC Advice: advice@fppc.ca.gov (866/275..3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Associacion Policical Accion Committee
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRI!3UTOR CONTRIBUTOR
II.FCOMMlna:.ALSO EtlTER I D NUMBER I CODE *
12/29 2016 Ronda Reese IKIIND
DeOM
[JOTH
DPTY
Dsce
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received tht"ough
intermediary: San Rafael Police Associacion,
1520 Fifth Avenue San Rafael CA 94901
09/30/2016 Peg9Y Ruge !KIIND
DeOM
DOTH
[JPTY
OSCC
10/20/2016
C/o, San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Associacion,
Fifth IKIIND
~~ n~
San Rafael, CA 94901 0 OTH
Union member's dues t"eceived through n PTY
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOVER
(IF SELi'-EMPLOYEO. ENTER NAME
OF IlUSINES$)
Corporal
City of San Rafael
Lead Communications
Dispatcher
City of San Rafael
Lead Communications
Oispatchet"
City of San Rafael
Statement covers period
from 09/25/2016
through _....;1:..:2:..!/-=3:..:1:..:;/-=2:..:0;.::1;.::6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 91 of _-,1",1..,2,,--
1.0. NUMBER
83155)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR VEAR
(JAN 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
12.70 294.30
12.70 294.30
incermediary: San Rafael Police Associacion, [JSCC
~~~~~~~1~1~.~~i~F~h Ayenue. San Rafael, CA 9490)~ ___ r-_____ ~_~~ __ ~~~ ____ +-_____ ~~~ _____ ~~~~ _________ _
11/05/2016 ?eg9Y Ruge !XjIND Lead Communications 12.70 294.30
C/o: San Rafael Police Association 1520 Fifch DCOM Dispatcher
Avenue City of San Rafael
San Rafael, CA 94901 0 OTH
On; on member' a dues rece i ved through 0 PTY
intermediary: San Rafael Police Association, osee
1520 Fifch Avenue. San Rafael, CA 94901
11 15 2016 E'eggy Rl.Jge [KlIND
C/o: San Rafael Police Association 1520 Fi fth OX COM
Avenue
San Rafael, CA 94901 DOTH
union member's due s rece i ved ~hrough 0 PTY
intermediary: San Rafael Police Association, osee
·Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g .. business entity)
PTY -Political Party
SCC -Small Contributor Committee
Lea Commun~cat~ons
Dispatcher
City of San Rafael
SUBTOTAL $
12.70 294.30
FPPC Form 460 (Janf2016)
FPPC Advice: advice@fppc.r::a.gov (866/27S-3n2)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Association Political Accion Commictee
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP COOE OF CONTRIBUTOR CONTRIBUTOR
(IF COMMmE€.ALSOENTER I,O,NLiMBER) CODE '*
11/30/2016 Peggy Ruge OOIND
C/o: San Rafael Police Association 1520 Fifth oeOM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received through OPTY
intermediary : San Rafael Police Associat:ion , OSCC
1520 Fifth Avenue San Rafael CA 91901
12/15/2016 Peggy Ruge IKJIND
C/o: San Rafael Police Associat:ion 1520 Fifth OCOM
Avenue
San Rafael, CA 94901 DOTH
Union member' 5 dues received through 0 PTY
intermediary: San Rafael ~olice Association, osee
12/29/2016 Peggy Ruge IXJIND
C/o: San Rafael Police Associacion 1520 Fi~th OCOM
Avenue
San Rafael, CA 94901 DOTH
Union member I s dues received through 0 PTY
intermediary: San Rafael Police Association, osee
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
Qf SELF· EMPLOYED. ENTER NAME
OF BlJSiNESS)
Lead Communications
Dispatcher
City of San Rafael
Lead communications
Dispatcher
City of San Rafael
Lead Communications
Oisoatcher
City of San Rafael
Statement covers period
from 09/25/2016
through _-=1:..:2c.:../..::.3..::.1 '---/2=-0:....:1:..:6'-----__
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 92 of 112
I.D .NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVETO DATE
CALENDAR YEAR
(JAN, , • DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12.70 294.30
12.70 294.30
12.70 294.30
1520' v uSn R 4 1 09/30/2016 Thomas Sabido -------r--~--IN-D----~r-O~f~f~i-c-e-r----------------~----------~1~6~.~J~0~----------~3~76~.2~O~------------------
C/o: San Rafael Police Association 1520 Fifth OIKl COM City of San Rafael
Avenue
San Rafael, CA 94901 DOTH
Union member' s dues rece i ved through 0 PTY
intermediary: San Rafael Police Association, osee
1520 Fifth Avenue, San Rafael. CA 94901
10 20 2016 Thomas Sa l. a IKI NO
C/o: San Rafael Police Associatl.on 1520 Fifth X ,
Avenue DCOM
San Rafael. CA 94901 0 OTH
Union member' B dues received through 0 PTY
interm7diary: San Rafael Police Association, osce
·Contributor Codes
IND -Individual
e OM-RecipientCommiltee
(other than PTY or seC)
OTH -Other (e .g ., business entity)
PTY -Political Party
see -Small Contributor Committee
0. lcer
City of San Rafael
SUBTOTAL $
16 .30 376.20
70,70 1
FPPC Form 460 (JanJ2016)
FPPC Advice : advice@fppc .ca.gov (866/275-37721
# --. -• -• _.
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Folice Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRI8UTOR CONTRIBUTOR
~fCOMMmeE.ALSOENTERI.O NUMBER) CODE *
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPlOYED. ENTER NAMt'
OF BUSINESSI
11/05/2016 Thomas Sab1do
C/o: San Rafael Police Associ ation 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1 5 20 Fifth Avenue San Rafael CA 94901
11/15/2016 Thomas Sabido
C/o: San Rafael police Association 1520 Fifth
Avenue
San Rafael , CA 94901
Union member's dues received through
intermed ~ary: San Rafael Police Associat10n,
11/)0/2016
12/15/2016
·Contributor Codes
!NO-Individual
eOM -Recipient Committee
(other than pry or SCC)
OTH -Other (e .g .• business entity)
PTY -Political Party
SCC - Small Contributor C ommitte e
Fifth
Fifth
Fifth
IRI IND o COM
DOTH
OPTY
osee
!!lIND
DCOM
DOTH
DPTY
OSCC
~IND
DCOM
DOTH
DPTY
osee
OOIND
DeoM
DOTH
OPTY
osee
!K1IND
DeOM
DOTH
UPTY
OSCC
Office,,'
City of San Rafael
officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
o 1cer
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
~rough ___ l_2~/~3_1~/_2~0_1_6 ____ ___
SCHEDULEA (CaNT.)
CALIFORNIA 460
FORM
Page 9 3 of 112
1.0. NUMBER
931 553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIREDI
16 .30 376 .20
16.30 376.20
16 .30 376 .20
16 .30 376 .20
J. . 376.20
91. 50 I
FPPC Form 460 (JanJ2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Association Political Action Committee
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IFCOMMIITEE. ALSO am:R I D NUI.IBER) CODE *
09/30/2016 Anthony Scalercio IRIIND
c/o: San Rafael Police A.ssociation 1520 f'ifch oeOM
Avenue
San Rafael, CA 94901 DOTH
Union member' s dues recel. ved through 0 PTY
intermediary : San Rafael Police A6sociacion, OSCC
~~~~~~~l~~fjfth Avenue San Rafael CA 94901
10/20/2016 Anthony Scalercio !!lIND
C/o: San Rafael Police A.ssociacion 1520 Fifth oeOM
Avenue
San Rafael, CA 94901 DOTH
Onion member' s dues received t.hrough 0 PTY
interm~diary: San Rafael Police Association, OSCC
11/05/2016 Anthony Scalercio IX]IND
C/o: San Rafael Police Association 1520 Pi ",th 0 COM
Avenue
San Rafael, CA 94901 DOTH
Onion member's dues received through 0 PTY
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
IIF SEI,F·EJ,IPLOYEO, ENTER NAME
OF eUSINESS)
Office:r
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Statement covers period
rrom 09/25/2016
through _....;1:;..2;;.;/...;3...;1,,-/...;2..;.0.:;.1.;;..6 __ _
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page _--=-94~ of 112
I.D.NUMBER
B31553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATlVETO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
16.30 376.20
16 .30 376.20
intermediary: San Rafael Police Association, OSCC
--:-~,.."....",...,,...,....,,--+-!l.5.~E.iE th Ayenue. ~~-""-..!d:l_.z.:L.z.;!.01!....-__ --l _____ -+~-;;-;---:-: _________ +-____ ---:-~-::-::+-____ ----::-::-:::-::-::-t-_______ _
11/15/2016 Anthony Scalercio IRJIND Officer 16,30 376.20
C/o; San Rafael Police ASsociation 1520 Fifth X City of San Rafael
Avenue oeOM
San Rafael, CA 94901 D OTH
Onion member's dues received through 0 PTY
intermediary : San Rafael Police Association, OSCC
-'>T-~~~~~1~5~20 Fifth Avenue, San Rafael, CA 94901
11 30 2016 Antnony S ca ercl.O 00
C/o; San Rafael Police Association 1520 Fifth X INO
Avenue OCOM
San Rafael, CA 94901 OOTH
Union member' s dues received through 0 PTY
in~e~ediary: San Rafael Police Association, OSCC
·Contributor Codes
IND -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g .• business entity)
PTY -Political Party
SCC -Small Contributor Commil1ee
o lcer
City of San Rafael
SUBTOTAL $
16.30 376.20
91. 50 I
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275..3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police ASsociacion poli~ical Accion Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF· EMPLOYED. ENTER NA1.lE
OFBLIS'NESS)
(IF CO.'>IMIITEE. ALSO ENTER 1.0. NUMBERI CODE ...
12 15/2016 Anthony Scalercio
C/o: San Rafael ~olice Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael ~olice Association,
1520 Fifch Avenue San Rafael CA 94901
12/29/2016 Anthony Sca1ercio
C/o: San Rafael Pol~ce Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael ?olice Associacion,
. 4
09/30/2016 George SchkKore
C/o: San Rafael Police ASBociat~on 1520 Fifth
Avenue
San Rafael, CA 94901
Unlon member's dues received through
intermediary: San Rafael Police Associacion,
1520 Fift:h Av n
10/20/2016 George Schikore
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
11 05 2016 George Sc k ore
C/o: San Rafael Police Association 1520 Fifch
Avenue
San Rafael, CA 94901
Union member's dues received chrough
~ncermediary: San Rafael Police Association,
·Contributor Codes
IND -Individual
Pi ftb Ayenue, San Ra~ 4
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e,g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
IR]INO
DCOM
DOTH
DPTY
DSCC
IKJIND
DCOM
DOTH
DPTY
osee
IX]INO
DCOM
DOTH
DPTY
osce
IRJINO
DCOM
DOTH
DPTY
Dsec
IR]INO
DCOM
DOTH
DPTY
OSCC
officer
Cicy of S~~ Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
O_~kcer
Cicy of San Rafael
SUBTOTALS
Statement covers period
from 09/25/2016
~rough __ ~l~2~/~3~1~/~2~0~l~6 ____ __
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 95 of_-,-1,,-12~
I.D.NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVETO DATE
CALENDAR YEAR
(JAN. 1 • DEC. 31)
PER ELECTlON
TO DATE
(IF REQUIRED)
16 .30 376.20
16.30
16,30 376,.20
16.30 376.20
16.30 376.20
81. 50 I
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275·3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police ASsociation Political Action Committee
Amounts may be rounded
to whole dol la rs.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOVER
(IF SELF·EMPLOYED, ENTER NAME
OF6US1NESS)
(IFCOMMITIEE.ALSOENTERI.D.NuMe~RI CODE *
11 15/2016 George Schikore
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
i.ntermediary: San Rafael Police Association,
Ij20 Fifth Avenue San Rafael CA 94901
11/30/2016 George Schikore
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
12/15/2016
12/29/2016
09 30 2016
'Contributor Codes
I ND -Individual
COM -Recipient Committee
(other than PTY or seC)
OTH -Other (e.g., business entity)
PTY -Political Party
see -Small Contributor Committee
Fifth
Fifth
Fifth
!!lIND
DCOM
DOTH
OPTY
osee
[KIIND
OCOM
DOTH
OPTY
DSCC
IRlIND
DCOM
DOTH
OPT'(
osee
IRlINO
DCOM
DOTH
DPTY
DSCC
IR]INO
DCOM
DOTH
OPTY
osee
Officer
City of San Rafael
Officer
Cicy of San Rafael
Officer
Cicy of San Rafael
Officer
City of San Rafael
o _l.cer
Cicy of San Rafael
SUBTOTAL $
Statement covers peri od
from 09/25/2016
through _....:1:..:2;.:../..:.3..:.1.:.../.:..20.:..1:...6:....-__
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page _-=-96~ of 112
1.0 NUMBER
631553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 . DEC J1)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
16.30 376.20
16.30 376.20
16.30 376.20
1 .3 376.20
B1. 50 I
FPPC Fonn 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
SCHEDULEA (CaNT.) Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
Statement covers period
CALIFORNIA 460
FORM
NAME OF FILER
San Rafael Police Association Political Action Committee
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR COfllTRISurOR
(IFCCMMITTEf.ALSOEN'dHO NUt0.4eER) CODE *
from 09/25/2016
through __ 1_2..;../_3_1/;....2_0_1_6 __ _
1.0. NUMBER
831553
IF AN INDIVIDUAL. ENTER AMOUNT CUMULATIVE TO DATE
OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR
PER ELECTION
TO DATE
(IF REQUIRED) (IF SElf·EMPlOYED. EIITER NAME PERIOD (JAN . 1 -DEC . 31)
~10~/'2~0~/T.2-'0~1~6.-rJ~u~s~t~~~·n~s~c~hr~a~e~d~e7.r~----------------------------r-~------~~O~f7fTi=c=er=--Q-f-a-~-I-NE-SS~)------~----------~1~6~.~3~04-----------3~7~6~.2~O~------------------IKlIND C/o; San Rafael Police Association 1520 Fifth City of San Rafael
AVC:1Ue oCOM
San Rafael, CA 94901 DOTH
Union member's dues received through D PTY
intermediary: San Rafael Police Association, DSCC
1520 Fifth Avenue San Rafael CA 94901
11/05/2016 Justin Schraeder IKIIND
C/o: San Rafael Police Association 1520 Fifth DeOM
Avenue
San Rafael, CA 94901 DOTH
union member's dues received through D PTV
interm7diary : San Rafael Police Association, Dsce
11/15/2016
Fifth
11/30/2016
Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
~~~~~~~1S~2~0 Fifth Avenue, San Rafael, CA 94901
12 1S 2016 JustIn' 'sc rae er
c/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermedlary : San Rafael Police ASsociation,
'Contributor Codes
lNO -Individual
COM -Recipient Committee
(other than PlY or SCC)
OTH -Other (e .g ., business entity)
PTY -Political Party
SCC -Small Contributor Committee
IKlIND
DeOM
DOTH
DPTV
DSCC
IKlIND
DeOM
DOTH
DPTV
DSCC
IR]IND
DeOM
DOTH
DPTY
osce
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Of l.cer
City of San Rafael
SUBTOTAL $
16 .30 376 .20
16.30 376 .20
16.30 376.20
16.30 376.20
81. 50 I
FPPC Form 460 (JanJ2016)
FPPC Advice : advice@fppc_ca .gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Polit~cal Act~on Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL . ENTER
OCCUPATION AND EMPLOYER
(If sa.,<.EMPlOVEO. E~ NAME
o~ BUSiNESS)
(IFCOMMrTTEE. ALSO ENl"ER 1.0 . NUMOERI CODE *
12/29 2016 Justin Schraeder
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
inte rmediary: San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
09/30/2016 Wanda Spaletta
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
tJ:\ion member's dues received through
~ntermediary: San Rafael Police Association,
10/20/2016
11/05/2016
'Contributor Codes
IND -Individual
. ~
COM -Recipient Committee
(other than PTY or seC)
OTH -Other (e .g ., business entity)
PTY -Political Party
SCC -Small Contributor Committee
Fifth
Fifth
Fifth
OOIND
oeOM
DOTH
oPTY
oSCC
@IND
oeOM
DOTH
oPTY
osee
lKJlND
DeOM
DOTH
DPTY
osee
lKJlND
oeoM
DOTH
oPTY
osee
IKJIND
oeoM
DOTH
oPTY
oscc
Officer
City of San Rafael
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Sergeant:
City of San Rafael
Sergeant
City of San Rafael
SUBTOTAL $
Statement covers period
from 09/25/2016
through ... _ ':.2/31/2016
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page 98 of.. 112
LD.NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATNETO DATE
CALENDAR YEAR
(JAN. 1 . DEC . 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16 .)0 376.20
16.30 376 .20
16.30 376.20
16.30 )76 .20
1 ,3 )76 .20
81.5°1
FPPC Form 460 (JanI2016)
FPPC Advice: advice@fppc.ca.gov (8661275--3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael ~olice Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
IIF SELF·EMPLOYED. ENTER NAME
Of aUSINESS)
QF COM foIlTTEE. ALSO ENTER I O. NUMBER I
11/30/2016 'iWanda Spalecta
C/o: San Rafael Police Association 1520 Fifch
Avenue
San Rafael, CA 94901
Union member's dues received chrough
intermediary: San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
12/15/2016 Wanda Spaletta
C/o: San Rafael Police Association 1520 Fifch
Avenue
San Rafael, CA 94901
Union member's dues received chrough
incermediary: San Rafael Police ASsociation,
12/29/2C16 wanda Spa1etta
C/o: San Rafael Police Association 1520 Fifch
Avenue
San Rafael, CA 94901
Union member's dues received chrough
incermediary: San Rafael Police Association,
-;--;-:-""""''''-_''''-1-''1:1 P . f h Av n Ra flO 1
09/30/2016 Lynecte Starnes
C/o: San Rafael Police Associacion 1520 Fitch
Avenue
San Rafael, CA 94901
Union member's dues received chrough
intermediary: San Rafael Police Association,
1520 Fi ft h Avenue, San Rafael, CA 94901
10 20 2016 Lynet te Starnes
C/o: Sa n Raf ael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
union member'6 dues received through
intermediary, San Rafael Police Associarion,
'Contributor Codes
INO -Individual
, h 4
COM -Recipient Committee
(other than PTY or seC)
OTH -Other (e.g., business enllty)
PTY -Political Party
see -Small Contributor Committee
CODE *
OOIND
oCOM
DOTH
oPTY
oscc
OOIND
DCOM
DOTH
DPTY
.OSCC
®IND
oCOM
DOTH
OPTY
OSCC
®IND
OCOM
DOTH
oPTY
osee
IIDINO
oCOM
DOTH
oPTY
oscc
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Community Service Officer
City of San Rafael
Cammun1ty S e~1ce 0 1cer
Cit y of San Rafael
SUBTOTAL $
Stateme nt covers period
~om C9/25/2016
th rough _....;1:..2:..:/....;3:...:1:..:c/....;2:...:0....;1;..:6" __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 99 of _. 112
I.D.NUMBER
e31SS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
376.20
16.30 376.20
16.30 376.20
12.70 294.30
12.70 2.94.30
FPPC Form 460 (Jan/2016)
FPPC Advice: advlce@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Assoc~ation Poli~ical Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IF COMMITTEE. ALSO ENTER 1.0 NUMBER I CODE *
IF AN INDNIDUAL. ENTER
OCCUPAilON AND EMPLOYER
(IF SEI.F-EMP~OVCD. ENTER NAIolE
OF BuSINESS)
11 OS/2016 Lynette Starnes
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
1~20 Fifth Avenue San Rafael CA 94901
11/15/2016 Lynet te Starnes
11/30/2016
C/o: San Rafael i'olice Association 1 520 Fifth
Avenue
San Rafael, CA 9490]
Union member's dues received through
intermediary : San Rafael Police Association,
1
Fifth
12/15/2016 Lynette Starnes
C/o: San Rafael Police Associat~on 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
12 29 2016 Lynette Starnes
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
'Contributor Codes
INO -Individual
COM -Recipient Committee
(olher than PTY or SCC)
OTH -Other (e .g., business entity)
PTY -Political Party
sec -Small Contributor Committee
IKIIND
DCOM
DOTH
UPTY
OSCC
[IDINO
oCOM
DOTH
oPTY
oscc
lKllND
OCOM
DOTH
oPTY
oSCC
IK)INO
DeOM
UOTH
DPTY
OSCC
OO IND
oeOM
DOTH
oPTY
Dsce
Community Service Officer
City of San Rafael
community Service Officc;-
City of San Rafael
Community Service Ofticer
City of San Rafael
Community Service Officer
City of San Rafael
Commun~ty Serv~ce 0 ~cer
City of San Rafael
SUBTOTAL $
Statement covers period
~om 09/25/2016
th ro ugh __ 1::..:2::..!/~3:..:1:..!/..:2:..:0:..:1:..:6~ __
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page _--=-10::.,:0::... of 112
1.0. NUMBER
8J155J
AMOUNT
RECEIVED THIS
PERIOD
CUMULATNETO DATE
CALENDAR YEAR
(JAN . 1 -DEC. 31)
PER ELECTION
TO DATE
(tF REQUIRED)
12.70 294 .30
12 .70 294.30
12 .70 294 .30
12.70 294.30
12.70 294.30
63 .5°1
FPPC Form 460 (Janl2016)
FPPC Advice: advice@fppc.ca .gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Policical Accion Committee
Amounts may be rounded
to whale dallars.
DATE
RECEiVED
FULL NAME. STREET ADDRESS AND ZIP CODe OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOVER
(IF SaF·El\.IPLOVEO. ENTER NAME
OF eUS1N ESS)
(tFcOt.CIoIIn£e. ALSO IONTER I 0 NUM~I CODe *
09 30 2016 Chrlstopher Sweeney
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael , CA 94901
Union member's dues received through
intermediary: San Rafael Police Associacion.
1520 Fifch Avc~ue San Rafael CA 94901
10/20/2016 Christopher Sweeney
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael. CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
11/05/2016 Christopher Sweeney
C/o: San Rafael Police Associa~ion 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Pol :.ce Association,
1520 F 'fth Aven e San Rafael A 4 1
11/15/2016 Christopher Sweeney
C/o: San Rafael Police Association :~20 Fifth
Avenue
San Rafael , CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue, San Rafael. CA 94901
C lSCOp er Sweeney
C/o : San Rafael police Association 1520 Fifth
'Contributor Codes
IND -Individ ual
COM -ReCipient Committee
(other than PTY or seC)
OTH -Other (e.g .• business entity)
PTY -Political Party
SCC -Small Contnbutor Committee
IR]IND
DeOM
DOTH
DPTY
osee
IRJIND o cOM
DOTH
DPTY
osee
~IND
D eOM
DOTH
DPTY
o see
IR]IND
o eoM
DOTH
DPTY
osee
IR]IND
oeOM
DOTH
oPTY
osee
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
Officer
City of San Rafael
o J.cer
City of San Rafael
SUBTOTAL $
Statemcntcovers period
from 09/25/2016
throug h _....;1....;2..:../_3_1/:....2.;....0-,-1....;.6 __ _
SCHEDULE A (eONT.)
CALIFORNIA 460
FORM
Page_--=-lO=lo.. of 112
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 • DEC . 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
16 .30 376 .20
16 .30 3 7 6 .2 0
16 .30 376 .20
16.30 376 .20
FPPC Farm 460 (Jan/2016)
FPPC Advice : advice@fppc .ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Act~on Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SElf. E"IPLOYED. ENTER NAA4 F
OF BUSINESS)
(IF CO.'.1 MlnEE. ALSO ENTER 1.0 NUMBER) CODE *
12 15/2016 Christopher Sweeney
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
i~termediary: San Rafael ?olice ASsociation,
1~20 Fifth Avc~ue San Rafael CA 94901
12/29/2016 Christopher Sweeney
C/o: San Rafael Police Association 1520 F~fth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael police Association,
09/30/2016
10/20/2016
·Contributor Codes
INO-Individual
COM -Recipient Committee
(other than PTY or seC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
Fifth
Fifth
Fifth
I!lIND
DeOM
DOTH
DPTY
Dsce
IRJIND
DeOM
DOTH
OPTY
USCC
OOIND
DCOM
DOTH
DPTY
osee
IKJ IND
D COM
D OTH
D PTY
o see
IKJIND
oeOM
DOTH
DPTY
osec
Officer
City of San Rafael
Office r
City of San Rafael
Civilian Supervisor
City of San Rafael
Civilian Suoervisor
City of San-Rafael
C~v~ ~an Suoervlsor
City of San-Rafael
SUBTOTAL $
Stateme nt covers period
hom 09/25/2016
through _....:1:..;2,-,/....:3....:1:..:./....:2....:0....:1....:6 __ _
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Pi:lge _--=10::..:2=-of 112
I.D.NUMBER
B3155 3
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
16.30 376.20
12.70 294.30
12,70 294.30
12.70 294.30
FPPC Fonn 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3n2)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Poli~ical Ac~ion Commi~tee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED. ENTER NAME
or-BUSINESS)
(IF COIolMilTEE.AlSOEN7~R 1.0. NUMBER) CODE *
11/15/2016 CharlyTaylor
C/o, San Rafael Police Association 1S20 Fifth
Avenue
San Rafael, CA 94901
Union member's d~cs received through
intermediary : San Rafael Police Association,
1520 Fi fth Avenue San Rafael CA 94901
11/30/2016 Charly Taylor
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
interm7~iary: San Rafael Police Association,
12/15/2016
12/29/2016
09 30 2016
·Contributor Codes
I ND -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
s ee -Small Contributor Committee
Fifth
Fifth
Fifth
OOIND
neOM
DOTH
DPTY
osee
IKJIND
DeoM
UOTH
DPTY
oscc
fRIlND
neOM
DOTH
DPTY
osec
IIIIND
oeOM
nOTH
DPTY
osee
IK]INO
DeoM
DOTH
OPTY
osee
Civilian Supervisor
City of San Rafael
Civilian supervisor
City of San Rafael
Civilian Superv1sor
City of San Rafael
Civilian superv1sor"
City of San Rafael
o leer
City of San Rafael
SUBTOTALS
Statement covers period
from 09/25/2016
through __ 1_2..:../_3_1.;../_2_o 1_6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page 103 of 112
1.0. NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN 1 -DEC 31)
PER ELECTION
TO DATE
(IF REQUIRED)
12.70 294.30
12.70 294.30
12.70 294.30
12.70 294.30
16.30 376.20
FPPC Form 461l (JanI21l16)
FPPC Advice: advice@fppc,ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association political Action Commictee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SEI.F·E/J.PLOVED. ENTER NAME
OF 8USlNESS)
10
11
(IFCOMWnEE, ALSO ENn;:R I 0 NUMBER)
2016 Henry rre
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
interm7diary: San Rafael Police Association,
Fifth
Fifth
Henry Tirre
C/o; San Rafael Police Association 1520 F~fth
Avenue
San Rafael, CA 94901
Union member's dues received through
'inte~edia~: San Rafael Pol~ce Association,
1520 Fif~h Avenue San Rafael CA 94901
Henry T~rre
c/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues rece1ved throuah
intermed ia ry : San Rafael Police As~ociation,
CODE *
IR]IND
DCOM
DOTH
OPTY
osce
IK]IND
DCOM
DOTH o PlY
osee
IXlIND
DeOM
DOTH
DPTY
D sec
IXlIND
DeOM
D OTH
O PTY
o sec
IRJIND
oeOM
DOTH
OPTY
oscc
San Rafael
San Rafael
Officer
City of San Rafael
J.cer
City of San Rafael
SCHEDULEA (CONT.)
~----SS~~~~~mue~n~t~c~o~v~e~~~p;erirl~o~d~---'~~~~~~~
from 09/25/2016
through 12/31/2016 Page 1 0'1 of __ ...;1::.;1.::.;2=---
1.0 NUMBER
AMOUNT
RECEIVED THIS
PERIOD
1
16.30
16.30
16.30
1
831553
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
)
376.20
376.20
376.20
3
PER ELECTION
TO DATE
(IF REQUIRED)
SUBTOTAL $ 81. 50 I
'Contributor Codes
I ND -Individ ual
eOM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
FPPC Form 460 (JanJ2016)
FPPC Advice: advice@fppc.ca.gov (8661275-3772)
_ &--. -.. --~ - - ---~-
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael ~olice Associaeion Po11t~cal Aceion Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR tF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SElf· EMPLOYED, ENTER NAME
or 6LSNESSI
(IF COMMJTTEc. AlSOENTElHO NUM6ERI CODE *
12/29/2016 Henry Tirre
C/o : San Rafael Police Associaeion 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
09/30/2016 Michael Vergara
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
interm~diary; San Rafael Police Association,
10/20/2016 Michael Vergara
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
union member's dues received through
intermediary: San Rafael ,'alice Association,
1520 Fi h Avenu a R 1
11/05/2016 Michael Vergara
C/o: San Rafael Police Associaeion 1520 F~fth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue, San Rafael, CA 94901
Ml.c ae Vergara
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
'Contributor Codes
INO -Individual
. Av 4
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
!E)IND
UCOM
DOTH
OPTY
OSCC
!K)IND
DCOM
DOTH
DPTY
oSCC
IX)IND
DCOM
DOTH
oPTY
oscc
IRJIND
DOOM
DOTH
DPTY
DSCC
IK)IND
DCOM
DOTH
UPTY
OSCC
Officer
City of San Rafael
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Sergeant
City of San Rafael
SUBTOTAL $
Statement covers period
hom 09/25/2016
th roug h _--=1:...:2-,--/-".-3-",1/,--,2:...:0:...:1--=6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page _-=10,,-,5,-of 112
I.D.NUMBER
831553
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 • DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
16 .30 376.20
16.30 376.20
11;.30 376,20
16.30 376.20
91. 50 1
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/27S-3n2)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF FILER
San Rafael Police Association Political Action Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTeR
OCCUPATION AND EMPLOYER
IIF SELF·EMPU)Y£D. ENTER NAME
Of BUS1NESS)
(IF COMMITTEE. AlSO ENTER 1.0. NUM8~R)
11 30/2016 Michael Vergara
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
12/15/2016 Michael Vergara
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
interm7diary: San Rafael Police Association,
12/29/2016
09/30/2016
'Contributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
Fifth
Fif t h
Fifth
CODE ..
I&]IND
DCOM
DOTH
DPTY
osee
IKIIND
DCOM
DOTH
D PTY
osce
[RJIN D
oeOM
DOTH
OPTY
osee
OOIND
DeOM
DOTH
DPTY
osee
IRlfND
DCOM
DOTH
DPTY
osee
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Sergeant
City of San Rafael
Officer
City of San Rafael
o .leer
City of San Rafael
SU8TOTAL$
Statement covers peri od
from 09/25/2016
~rough __ ~1~2~/~3~1~/~2~0~1~6 ____ ___
SCHEDULE A (CaNT.)
CALIFORNIA 460
FORM
Page 106 of 112
LD. NUMBER
83155J
AMOUNT
RECEIVED THIS
PERIOD
CUMULATNETO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELEcnON
TO DATE
(IF REQUIRED)
16.)0 376.20
16.30 376.20
16.30 )76.20
16.30 )76,20
16.30 376.20
81. 50 I
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
NAME OF FILER
San Rafael Police Association Political Action committee
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRI8UTOR CONTRJ8UTOR
(iF Co.l.1MITTEE, ALSO ENTER I D. NUMeER) CODE *
11/05/2016 Mark Wllklnson ~IND
DCOM
DOTH
DPTY
Dsec
C/o ; San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
~~~~~~~lS20 Fifth Avenue San Rafael CA 94901
11/15/2016 Ma r ~ Wilkinson
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary, San Rafael Pol~ce Association,
~INO
DCOM
DOTH
OPTY
osce
11/30/2 016 Mark Wilkinson IRJINO
C/o : San Rafael Police Association 1520 Fifth D eOM
Avenue
San Rafael, CA 94901 DOTH
Union member's dues received throu9h 0 PTY
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF·E.\APLOYEO, ENTER NAME
OF BUSINESS)
Officer
City of San Rafael
Of ficer
City of San Rafael
Officer
City of San Rafael
Statement covers period
from 09/25/2016
th ro ugh __ 1"'2"'/'-'3:..;1:..:/...:2:..;0:..::1:.:6'--__
SCHEDULEA (CaNT.)
CALIFORNIA 460
FORM
Page 107 of_..:.1.::.;12=--
I.D.NUM8ER
8Jl5S3
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 . DEC . 31)
PER ELECTION
TO DATE
(IF REQUIRED)
16.30 376.20
16 .30 376.20
16 .30 3 7 6.20
intermediary: San Rafael Police Association, o see
1520 Fifth v a f~~~~~4~A-______ ~---------4~~--------------------4_------------__ +_----------------~-----------------
12/15/2016 Mark wilkinson 00 NO Officer 16.)0 )76.20
C/o: San Rafael Police Association 1520 Fifth OX ~OM City of San Rafael
Avenue
San Rafael , CA 94901 DOTH
Onion member's dues recei vea l:.hrough 0 PTY
intermediary : San Rafael Police Association, [Jsee
1520 Fifth Avenue , San Rafael, CA 94901
Mark I'll. k~nson !Kl i 0
C/o: San Rafael Police Associa~ion 1520 Fifth X N
·eontributor Codes
INO -Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business enlity)
PTY -Political Party
SCC -Small Contributor Committee
DCOM
DOTH
DPTY
osee
o ~cer
City of San Rafael
SUBTOTAL$
16 .30 376.20
81.50 1
FPPC Form 460 (Jan/Z016)
FPpe Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet)
Monetary Contributions Received Amounts may be rounded
to whole dollars.
Statement covers period
from 09/25/2016
throug h _....;1;;.;2;;.:/....;3;.:1:..:./...::2;.:0..::1",6 __ _
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
Page lOB of 112
._ .. ____ ~-------------------------------------------------------------------------L--------------------____ ~~~~~----------~ NAME OF FILER 1.0. NUMBER
San Rafael Police Association Political Action Committee
nATE
RECEIVED
FULL NAME. STREET AODR ESS AND ZI P CODE OF CONTRIBUTOR CONTRIBUTOR
(IFco~!.\mEE .AtSOENTERID.NUMB9'i) CODE *
09/30/2016 Bianca Wilmott
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fifth Avenue San Rafael CA 94901
10/20/20i6 Bianca Wilmott
C/o : San Rafael Police Associa~ion 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
11/05/2016 Bianca Wilmott
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police Association,
1520 Fi a 4
11/15/2016 Bianca Wilmotc
C/o: San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary : San Rafael Police Association,
1520 Fifth Avenue , San Rafael, CA 94901
11 )0 2016 Bianca Wllmott
C/o : San Rafael Police Association 1520 Fifth
Avenue
San Rafael, CA 94901
Union member's dues received through
intermediary: San Rafael Police ASSOCiation,
'Contributor Codes
IND -Individual
..
COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e .g ., business entity)
PTY -Political Party
see -Small Contributor Committee
OOIND
oeoM
DaTI-!
oPTY
osee
OOIND
oeoM
DOTH
oPTY
osee
OOINO
o eOM
DOTH
DpTY
osec
!&lIND
DeoM
DOTH
DPTY
osee
lK)INO
oeOM
DOTH
OPTY
OSCC
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SEtF·fMPU)YED. ENTER NAME
OF IlUSINE$S)
Police Officer
City Of San Rafael
Police Officer
City of San Rafael
Police Officer
City Of San Rafael
Police Officer
City Of San Rafael
SUBTOTAL $
AMOUNT
RECEIVED THIS
PERIOD
16.30
16 .)0
16.30
16.30
16,30
81. 50 I
811SS)
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC 31)
32B.30
32B.30
328.30
32B.30
328.30
PER ELECTION
TO DATE
(IF REQUIRED)
FPPC Fonn 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule C
Nonmonetary Contributions Received
seE INSTRUCTIONS ON REVERSE
NAME OF FILER
Amounts may be rounded
to whole dol la rs.
San Rafael Pol~ce Association Political Action committee
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND
ZIP CODE OF CONTRIBUTOR
IIF COMMITTEE. AlSO ENTER 10. NUMSER I
IF AN INDIVIDUAL . ENTER
CONTRIBUTOR OCCUPATION AND EMPLOYER
CODE *
OIND
DeOM
DOTH
DPTY
osee
DIND
oeOM
DOTH
o PlY
osee
DIND
DeOM
DOTH
DPTY
o see
DIND
oeOM
DOTH
DPTY
osee
(If SE\.F-€MPlOYEO. ENTER
NAME OF BUSINESS)
Attach additional information on appropriately labeled continuation sheets.
Schedule C Summary
1. Amount received this period -itemized nonmonetary contributions.
SCHEOULEC
Statement covers period CALIFORNIA 460
FORM from 0 9 /2 5/2016
through 12/31/2016
DESCRIPTION OF
GOODS OR SERVICES
SUBTOTAL $
AMOUf'IT1
FAIR MARKET
VALUE
I.D.NUMBER
B31553
CUMULAT IVE TO
DATE
CALENDAR YEAR
(JAN 1 -DEC 31)
'Contribulor Codes
INO -Individual
PER ELECTION
TO DATE
(IF REQUIRED)
(Include all Schedule C sUbtotals .) ..................................................................................................................... $ ____ --=-0.:....:.0..:,0 COM -Recipient Committee
(other than PTY or seC)
OTH -Other (e.g .• business entity)
PTY -Political Party
2 . Amount received th is period -unitemized nonmonetary contributions of less than $100 .................................... $ ___ . __ -"-s ~o ,-,. 0=0
3. Total nonmonetary contributions rece ived this period. SCC -Small Contributor Committee
(Add Li nes 1 and 2 . Enter here and on the Summary Page, Column A , Lines 4 and 10.) ...................... TOTAL $ ______ 5_0_.0"-0
FPPC Form 460 IJanl2D16)
FPPC Advice : advice@fppc .ca .gov (866/275-3772)
SCHEDULE E
Schedule E
Payments Made Amounts may be rounded
to whole dollars,
Statement covers period
from 09/25/2016
CALIFORNIA 460
FORM
SEE INSTRUCTIONS ON REVERSE through _...;;1....;;2..:../..;;,3,;;.,1""/2_0_1_6'--__ Page ~ of ~ NAME OF FILER _________________________________________________________________ L-________________________ +_-I.~D-. -NU-M~BE~R----------~
San Rafael Pol~ce Associacion Po11tical Action Committee 8nSS)
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
OIJP campaign paraphernalia/misc. M3R member communications RAD radio airtime and production costs
eNS campaign consultants MTG meetings and appearances RFD returned cOrltributions
ClB contnbution (explain nonmonetary)" OFC office expenses SAL campaign workers' salaries
cve civic donations PET petition circulating Ta t.v. or cable airtime and production costs
FlL candidate tiling/ballot fees PHO phone banks TRC candidate travel, lodging, and meals
FI'D fund raising events POL polling and survey research TRS staff/spouse travel, lodging, and meals
lID independent eJCpenditure supporting/opposing others (explain)" POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor
LEG legal defense PRO professional services (legal, accounting) VOT voter registration
LIT campaign literature and mailings PRT print ads weB information technology costs (intemet, e-mail)
NAME ANO ADDRESS OF PAYEE
(IF COlll'>llnEE.ALSOENTER 1.0 NUMBERI CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
Donot" Stack, LLC WE~ 24.90
5940 College Avenue, Su i te F
Oakland, CA 94618
Donot" Stack, LLC WEB 51. )]
5 940 College Avenue, Suite F
Oakland, CA 94618
Donor Stack, LLC WEB 50.9B
5940 College Avenue, Suite F
Oakland, CA 94618
* Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 127,21
Schedule E Summary
1. Itemized payments made this period, (Include all Schedule E subtotals,) .. .,,, .... _,_,,.' ... ,,., .. __ ..... " .. _"."" .. "" .. " .... , .. "." ....... " ..... ,, .......................... $ ___ -=..1:...:, 1:..:.3-=..2:.,:.3:..::.8
2. Unitemized payments made this period of under $1 00 ...................................................... _ ................ , ,., ..... " .... "_, ........... _" ...... " ... _,,, ......... _ ....... $ __________ ---'o=-:.:....::o'-=-o
3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ...... " ...................... " ...... __ .................. _,_ .... _, .... _".,,' $ _____ "--0 _:....::0:..:.0
4. Total payments made this period. (Add Lines 1,2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ....... " .................... TOTAL $ ______ --=1..!,.,.=.13::.:2=-.:.:3:..::.B
FPPC Form 460 (Jan/2016)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
, _ ~ _.c: _ ._ ~ _ _ _ __
Schedule E
(Continuation Sheet)
Payments Made
SEe INSTRUCTIONS ON....:.R.:..::E:...:V-=E"'R:.::S-=E ______ _
NAME OF FILER
San Rafael Police Association Political Action Commitcee
Amounts may be rounded
to whole dollars.
Statement covers period
from 09/25/2016
through 12/31/2016
SCHEDULE E (CONT.)
CALIFORNIA 460
FORM
1.0 NUMBER
831553
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
0vP
CNS
CTB evc
FIL
FI\O
m
LEG
UT
campaign paraphernalia/misc.
campaign consultants
contribution (explain nonmonetary)"
civic donations
candidate filing/ballot fees
fundraising events
independent expenditure supporting/opposing others (explain)"
legal defense
campaign literature and mailings
NAME AND ADDRESS OF PAYEE
(IF CCMMITrEE. AlSO ENTER '-0, NUMBER)
Donor Stack, LLC
5940 College Avenue, Suice F
Oakland, CA 94618
The Henry Levy Group
5940 College Avenue
Oakland, CA 94618
M3R
MTG
OFC
PET
PHD
POL
POS
Ff!O
PfIT
member communications
meetings and appearances
office expenses
petition circulating
phone banks
polling and survey research
postage, delivery and messenger services
professional services (legal, accounting)
print ads
CODE OR
WEB
PRO
• Payments that are contributions or Independent expenditures must also be summarized on Schedule D.
RAD
RFD
SAL
TEl...
me
TRS
TSF
VOT
IlVEB
radio airtime and production costs
returned contributions
campaign workers' salaries
Lv. or cable airtime and produdion costs
candidate travel, lodging, and meals
staff/spouse travel, lodging, and meals
transfer between committees of the same candidate/sponsor
voter registration
information technology costs (internet, e-mail)
DESCRIPTION OF PAYMENT AMOUNT PAID
51.62
953.55
SUBTOTAL $ 1,005.17
FPPC Form 460 (Jan/2016)
t:Dcr Tnll_t:.aa L.lal .... ll~a· DI::I:J/\ C:Ll' _t:'CDr laCC::J?7J:._ "177..,\
Schedule I
Miscellaneous Increases to Cash Amounts may be rounded
to whole dollars.
Statement covers period
from 09/25/2016
SC HEDULE I
CALIFORNIA 460
FORM
through 1 2/31/2016 Page ~ of 112 SEEINSTRuCnONSONREVER~S~E~ ____________________________________________________________ ~ ______________________ ~ __________________ ~
NAME OF FILER
San Raf a el Police Association Political Action Committee
DATE
RECE IVED
FULL NAME AND ADDRESS OF SOURCE
(If COMMllTEE. ALSO ENTER 1.0 NUMBER)
Attach additional information on appropriately labeled continuation sheets .
Schedule I Summary
DESCRIPTION OF RECEIPT
SUBTOTAL $
1. Itemized increases to cash this period .............................................................................................................. , .... n •• $ __________ o::..;.:..:o,-=-o
2. Un itemized increases to cash of under $100 this period , ............................................................................................ $ _________ ::..2:.;:' 1;.=.0
3, Total of all interest received this period on loans made to others . (Schedule H, Column (e).) ................................ $ ____ ---=-0:.;:.0:.::0
4. Total misce ll aneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the
Summary Page, Line 14.) ....................................... , ................ , .............................................................. TOTAL $ ____ ......;:,2,;..;.1:..;.0
1.0 . NUMBER
831553
AMOUNT OF
INCREASE TO CASH
FPPC Form 460 (Jan/20161
FPPC Advice: advice@fppc.ca .gov (866/275-3772)
- - -I 1 .•• ___ • ~ ___ _