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Form 410 - Kate Colin for San Rafael Mayor 2020 Amendment 2Statement of Organization Recipient Committee Statement Type ❑ Initial ® Amendment Q Not yet qualified or Q Date qualification threshold met Date qualification threshold met 12 / 2 / 2019 1. Committee InformationI I.D. Number (if applicable) 1423740 NAME OF COMMITTEE KATE COLIN FOR SAN RAFAEL MAYOR 2020 STREET ADDRESS (NO P.O. BOX) CITY STATF LIP CODE AREA CODE/PHONE San Rafael CA 94901 FULL MAILING ADDRESS IIF DIFFERENT) E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) COUNTY OF DOMICILEJURISDICTION WHERE COMMITTEE IS ACTIVE Marin City of San Rafael Attach additional information on appropriately labeled continuation sheets. fy;%, 11E lTermination — See Part 5 r Official Use Only IRD y JAN 2 1 20 Date of termination CITY CLERK'S OFFICE 2. Treasurer and Other Principal Officers NAME OF TREASURER Richard Kalish STREET ADDRESS (NO P.O. BOX) CITY San Rafael STATE CA ZIP CODE 94903 AREACODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) C17Y S1Aif ZIP CODE AREA CODE/PHONE NAME OF PRINCIPAL OFFICER(S) Kate Colin STREET ADDRESS (NO P.O. BOX) CITY San Rafael STATE CA ZIP CODE 94901 AREACDDE/PHONE 3. Verification I have used all reasonable diligence inpreparingthis ent and to the best of m knowledge the information contained herein is true and complete. I certiV un�4y��;.,:. g y g p fy der penalty of perjury under the laws of the State of C ifor ' at he fore oing is tru n orrect. Executed on January2 i, 2020 By DATE ) -- GATE Executed on DATE Executed on DATE SIGNATURE OF CONTROLLING OFFICEIJOLDER, CANDIDATE, OR STATE MEASURE PROPONENI By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT 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 CALIFORNIA' Recipient Committee • - INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER KATE COLIN FOR SAN RAFAEL MAYOR 2020 1423740 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION I AREA CODE/PHONE BANK ACCOUNT NUMBER Bank of Marin 415-482-2265 12861671 ADDRESS CITY STATE ZIP CODE 1101 Fourth Street San Rafael CA 94901 4. Type of Committee Complete the applicable sections. • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "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. ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECKONE • Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(5) NAME OR MEA5URE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO.. CITY OR COUNTY. AS APPLICABLE) SUPPn RT Nonpartisan Partisan (list political party below) Kate Colin Mayor 2020 FV] Nonpartisan Partisan (list political party below) • Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(5) NAME OR MEA5URE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO.. CITY OR COUNTY. AS APPLICABLE) FPPC Form 410(August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SUPPn RT OPPOSE SUPPORTOPPOSE 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 I I.D. NUMBER KATE COLIN FOR SAN RAFAEL MAYOR 2020 1423740 4. Type of Committee (Continued) Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY List additional sponsors on an attachment. NAME OF SPONSOR STREETADDRESS NO. AND STREET CITY GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE AREA CODE/PHONE lTOUOL.q.1❑ Date qualified S. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the following conditions have been met. • 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. -- 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 may be 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