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Form 460- Lucia Martel Dow for San Rafael School Board 2022; 12-31-21Recipient Committee COVER PAGE Campaign Statement�' 11,220 Dale Slamp E OWE Cover Page p (Government Code Sections 84200-84216.5) Statement covers period Date of election if app ' 1 4 (Month, Day, Year age of JAN 31 2022 from 01/01/2021 For Official Use Only SEE INSTRUCTIONS ON REVERSE through 12/31/2021 11/08/2022 I CLERK'S OFFICE 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. 2. Type of Statement: ❑X Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement Q State Candidate Election Committee Committee ❑x Semi-annual Statement ❑ Special Odd -Year Report Q Recall Q ControlledTermination Statement E]❑Supplemental Preelection (Also Complete Pan 5) Q Sponsored (Also file a Form 410 Termination) Statement - Attach Form 495 General Purpose Committee F-1General Complete Part 6) ❑ Amendment {Explain below) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER Treasurer(s) 1442869 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Lucia Martel Dow for San Rafael School Board 2022 Lucia Martel Dow MAILING ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Novato CA 94949-5731 ( CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Novato CA 94949-5731 ( Nancy L Warren MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE Novato CA 94949-5731 ( OPTIONAL: FAX/ E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification have used all reasonable diligence in preparing and reviewing this statement and to the best of ofSptxuor Executed on Dale Executed on Date By Signature of Controlling Officeholder, Candidate, Sale Measure Proponent By Sig nature of Controlling Offiiceholder.Candidate, State Measure Proponent 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 Lucia Martel Dow OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) School Board City of San Rafael RESIDENTIALIBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Novato CA 94949-5731 Related Committees Not Included in this Statement: List any committees not included /n this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) COVER PAGE - PART 2 Page 2 of 4 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTIONro SUPPORT OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidaie(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets If necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) Campaign Disclosure StatementSUMMARY Amounts may be rounded Statement covers period � - ISummary Page to whole dollars. rmwfrom 01/01/2021 _ SEE INSTRUCTIONS ON REVERSE NAME OF FILER Lucia Martel Dow for San Rafael School Board 2022 Contributions Received Column A TOTALTHIS PERIOD (FROM ATTACHED SCHEDULES) 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 0.00 Schedule E, Line $ 2. Loans Received...................................................... Schedule s, Line 3 7. Loans Made............................................................. 0.00 0.00 3. SUBTOTALCASH CONTRIBUTIONS ................ Add Lines 1 + 2 $ 0.00 0.00 4. Nonmonetary Contributions ............. Schedule C, line 3 Schedule FLine 3 0.00 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3+4 $ 0.00 Expenditures Made 6. Payments Made ....................................................... Schedule E, Line $ 0.00 7. Loans Made............................................................. Schedule tl, Line 3 0.00 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ 0.00 9. Accrued Expenses (Unpaid Bills) ............................... Schedule FLine 3 933.91 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 0.00 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8+9+10 $ 933.9.. Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 0.00 13. Cash Receipts ................................................... Column A, Line 3above 0.00 14. Miscellaneous Increases to Cash ........................... schedule /, Line 4 0.00 15. Cash Payments Column A, Line 8 above 0.00 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 0.00 if this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ 0.00 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 0.00 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 933.91 through 12/31/2021 Page 3 of 4 I.O. NUMBER 1992669 Column B Calendar Year Summary for Candidates CALENDAR YEAR Running in Both the State Prima and TOTALTO DATE g Primary General Elections $ 0.00 1/1 through 6130 7/1 to Date 0.00 $ $ 0.00 0. 0. $ 0.00 0.00 $ 0.00 933.91 0.00 $ 933.91 To calculate Column B, add amounts in Column A to 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 the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). 20. Contributions Received $ $ - 21. Expenditures Made $ $ - Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (if Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/ddtyy) $ Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. Statement covers period from 01/01/2021 through 12/31/202: SCHEDULEF Page 4 of 4 I.D. NUMBER Lucia Hartel Dow for San Rafael School Board 2022 11442869 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphemalia/misc. NSR member communications RAD radio airtime and production costs CNS campaign consultants WG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers' salaries CVC civic donations PEr petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure 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 Lrr campaign literature and mailings PRT print ads WEB information technology costs (Internet, e-mail) • Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS $ 0.00$ 933.91$ 0.00$ 933.91 Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) .......................................... INCURRED TOTALS $ 933.91 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................................. PAID TOTALS $ 0.00 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and onthe Summary Page, Column A, Line 9.)................................................................................................................................................ NET $ FPPC Form 460 (Jan12016) (a) I (b) (c) (d) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING AMOUNT INCURRED AMOUNTPAID OUTSTANDING IIF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD wepac LLC PRO/OFC 0.00 0.00 449.91 Novato, CA 94949 wepac LLC PRO/OFC 0.00 984.00 0.00 484.00 Novato, CA 94949 • Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS $ 0.00$ 933.91$ 0.00$ 933.91 Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) .......................................... INCURRED TOTALS $ 933.91 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................................. PAID TOTALS $ 0.00 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and onthe Summary Page, Column A, Line 9.)................................................................................................................................................ NET $ FPPC Form 460 (Jan12016)