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Form 410- Lucia Martel Dow for San Rafael School Board 20228 of emo- mt of orgy kaaUon TRI SCuPugnt C®MMMOL. Statement Type 0 onitiao [I Amendment Q Not yet qualified or Date qualification threshold met � Date qualification threshold met Termination ® See Part Date of termination OEC - 2 2021 CITY CLERK'S OFFI For Official use Only 9.6. Wiim --r— _— Z< Treasurer and Other Principal Officers 1. Committee Information (fapplicable) �. --- NAME OF COMMITTEE w NAME OF TREASURER Friends of Lucia Martel for San Rafael City Schools 2022 Lucia Martel Dora STREET ADDRESS (NO P.O. BOX) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE)PHONE CITY STATE ZIP CODE AREACODEIPHONE Novato CA 94949-5731 ( FULL MAILING ADDRESS (IF DIFFERENT) E-MAIL ADDRESS (REOUIREO)I FAX {OPTIONAL) mi.4TY ni newiti LE JURISDICTION WkfRE COMMITTEE IS ACTIVE Marin County 1 San Rafael Novato _ CA 94949-5731 ( NAME OF ASSISTANT TREASURER, IF ANY Nancy L Warren STRSET ADDRESS INH P.O.0OXI CITY STATE ZIP CODE AREACODEIPHONE Novato CA 94949-5731 ( NAME OF PRINCIPAI OFFIC@RIS} STREET ADDRESS IND P.O. ROXI CITY STATE ZIP CODE AREA CCOEOiiONE At -tach additional information on appropriately labeled continuation sheets. Tri " catib I have used all reasonable diligence in preparing Executed on DY DATE SIGNATURE OF CANT ROLU N6 QFF IC EHOLDE.R, CANDIDATE OR STATE MEASURE PROPONENT E7cecuted on BY DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPo7tENT FPPC Form 410 (August/2018) FPPCAdvice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Friends of Lucia Martel for San Rafael City Schools 2022 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION Bank of San Francisco ADDRESS AREA CODE/PHONE (415)744-6700 CITY BANK ACCOUNT NUMBER STATE ZIP CODE I.D. NUMBER 575 Market Street #900 San Francisco CA 94105 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 CHECK ONE Nonpartisan Partisan Lucia Martel Dow School Board City of San Rafael 2022 X Nonpartisan Partisan Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) IF A RECALL. STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) party party CHECK ONE T I OPPOSE OPPOSE FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Radpi ent committee INSTRUCTIONS ON REVERSE Friends of Lucia Martel for San Rafael City Schools 2022 4, Type (Continued) oppose specific g Y Not formed to support oro pecific candidates or measures in a single election. Checkonly one box: - ,..-( STATE Committee �? CITY Committee L0 CC9LBH7y Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY L�iW _I List additional sponsors on an attachment. NAME OF SPONSOR STREET ADDRESS No. AND STREET f5lwa WK, Date quallRed CITY GROUP OR AFFILIATION OF SPONSOR Page 3 of 3 STATE ZIP CODE Hn cn s° Termination Requirements fay signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the following conditions have been met: o 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; o 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 maybe used for political, legislative or governmental purposes under Government Code Sections 895 11 - 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