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HomeMy WebLinkAboutForm 410 - Police Association PAC Amend 01-09-20 (State)Statement of Organization Recipient Committee Statement Type ❑ Initial Amendment Q Not yet qualified or O Date qualification threshold met Date qualification threshold met t 01 / 01 .1 1983 1. Committee Information I.D. Number (if applicable) 831553 NAME OF COMMITTEE San Rafael Police Association Political Action Committee ❑ Termination—See STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 ( FULL MAILING ADDRESS (IF DIFFERENT) San Rafael, CA 94915-1557 E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) COUNTY OF DOMICILEI JURISDICTION WHERE COMMITTEE 15 ACTIVE Marin County, CA Attach additional information on appropriately labeled continuation sheets. I have used all reasonable diligence in preparing this statement penalty of perjury under the laws of the State of California Executed on 1/9/2020 By DATE Executed on By DATE Executed on By DATE Executed on DATE neffile.com By Date of termination 7 _Trnnenrnrr�i Date Stamp EIVED AND FILED Ah a office of the Secretary of State 5 of the Stele of CalMolllia 'JAN 15 2020 NAME OF TREASURER Ms. Beth Minka STREET ADDRESS IND P.O. BOX) Principal:Officer's J A N 3 ,q 2020' CITY STATE ZIP CODE AREACODE/PHONE San Rafael CA 94901 ( NAME OF ASSISTANT TREASURER, IF ANY Ms. Stacy E. Owens STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE Oakland CA 94607 ( NAME OF PRINCIPAL OFFICER(S) Mr. Chris Fuller, Vice President STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE San Rafael CA 94901 ( `,,,�,,,•��'.K�tsf .•vi'�?C-+'h�43�1,�ti��."n. �'�+,��"'i_'ys;�k.4+z�'�y�5.'a�'''-''.as'r'.a..�'iuti "nCk1e ._ ^,u�".: i�'�:�4..• "� best of my knowledge the information contained herein is true and complete. I certify under Ing is true and correct. SIGNATURE OF TREASURER OR ASSISTANT TREASURER SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee Statement Type 10 Initial NAME OF COMMITTEE Date Stamp Amendment 10 Termination — See Part 5 U Not yet qualified or 0 Date qualification threshold met I Date qualification threshold met / I —11 01 1 1983 I.D. Number (if applicable) 831553 San Rafael Police Association Political Action Committee STREET ADDRESS (NO P.O. BOX) STATE ZIPCODE AREA CODE/PHONE San Rafael CA 94901 ( FULL MAILING ADDRESS (IF DIFFERENT) San Rafael, CA 94915-1557 E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) COUNTY OF OOMIO LE JURISDICTION WHERE COMMITTEE IS ACTIVE Marin County, CA Attach additional information on appropriately labeled continuation sheets. I have used all reasonable diligence in preparing this statement jDdtp the best of my penalty of perjury under the laws of the State of California the f regoing is true Executed on 1/9/2020 By DATE_�....-- Date of termination e r NAME OF TREASURER Ms. Beth Minka STREET ADDRESS (NO P.O. BOX) For Official Use Only STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 ( NAME OF ASSISTANT TREASURER, IF ANY Ms. Stacy E. Owens STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Oakland NAME OF PRINCIPAL OFFICER(S) Mr. Chris Fuller, Vice President STREET ADDRESS (NO P.O. BOX) CA 94607 ( CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 ( TREASURER true a U Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, [ANDIDATEr ORSTATEMEASUREPRnfgj{EN ._. .......__.. _._.._. DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT u l Executed on DATE nefle.aom By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (August/2018) FPPC Advice- advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME San Rafael Police Association Political Action Committee I.D. NUMBER 831553 2a. Additional Officers / Assistant Treasurers NAME NAME Zachary Brickell, President MAILING ADDRESS MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 ( NAME NAME MAILING ADDRESS MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE NAME NAME MAILING ADDRESS MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREACODE/PHONE NAME NAME MAILING ADDRESS MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME I I.D. NUMBER San Rafael Police Association Political Action Committee 831553 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION Union Bank ADDRE55 AREA CODE/PHONE ( CITY BANK ACCOUNT NUMBER STATE ZIP CODE 3 of 4 San Rafael CA 94901 4T e'tiof..;Coinrnittee Complete the applicable'sections. • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." Stating "No party preference" is acceptable. • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECKONE Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEA5URE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE T OPPOSE OPPOSE FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME San Rafael Police Association Political Action Committee General Purpose Committee i' Not formed to support or oppose specific candidates or measures in a single election. Check only one box: 0 CITY Committee ❑ COUNTY Committee ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY I.D. NUM To make political contributions to support and oppose candidates and issues of interest to the San Rafael Police Association. Sponsored Committee ' List additional sponsors on an attachment. San Rafael Police Association Date qualified INDUSTRY GROUP OR AFFILIATION OF SPONSOR Union CITY San Rafael STATE ZIP CODE CA 94901 • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • This committee has no surplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. Page 4 of 4 AREA CODE/PHONE ( -- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. -- Leftover funds of ballot measure committees maybe used for political, legislative or governmental purposes under Government Code Sections 89511- 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov