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
(
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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