HomeMy WebLinkAboutForm 410 - Police Association PAC Amend 01-25-22 (State)Statement of Organization
Recipient Committee
Statement Type 10 Initial
U Not yet qualified
or
0 Date qualification threshold met Date
1. Committee Information I.D. Number
(if applicable)
NAME OF COMMITTEE
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F 2 0_2
❑ Termination — ee
CITY C ERK'S OFFICE Ir
01 01 / 1983 I
JAN 31 2022
CLERK'S OFFIC
831553 1 2. Treasurer and Other Principal Officers
San Rafael Police Association Political Action Committee
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)
JURISDICTION WHERE COMMITTEE IS ACTIVE
Attach additional information on appropriately labeled continuation sheets.
NAME OF FREASURER
For Official Use Only
xB 02 *22
Cynthia Morgan
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE AREA CODE/PHONE
San Rafael
CA
94901
(
NAME OF ASSISTANT TREASURER, IF ANY
Stacy E. Owens
STREET ADDRESS IND P.O. 90X}
-
CITY
STATE
ZIP CODE
AREA CODE/PHONE
Oakland
CA
94607
(
NAME OF PRINCIPAL OFFICER(S)
Lynn E. Murphy, Vice President
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
San Rafael CA 94901 (
3.._ Verification.:_:,. ,
II have used all diligence in preparing this
MEASURE PROPONENT
Executed on
DATE
netfile. com
By %---
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASVRE 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
Political Action Committee
2a. Additional Officers / Assistant Treasurers
NAME
Carl A. Huber, President
MAILING ADDRESS
CITY STATE ZIP CODE AREACODE/PHONE
San Rafael CA 94901 (
NAME
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODEIPHONE
NAME
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
NAME
I.D. NUMREf
831553
NAME
MAILING ADDRESS
CITY STATE ZIP CODE AREACODE/PHONE
NAME
MAILING ADDRESS
CITY STATE ZIP CODE AREACODE/PHONE
NAME
MAILING ADDRESS
CITY STATE ZIP CODE AREACODE/PHONE
_;)
NAMES 4"P
MAILING ADDRESS
MAILING ADDRESS
STA7E ZIP CODE ARF-ACODF)PHONE CITY STATE ZIP CODE AREACODE/PHONE
CITY
s
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
San Rafael Police Association Political Action Committee
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
union Bank
AREA CODE/PHONE
(915)259-2727
C{TY
BANK ACCOUNT NUMBLK
STATE ZIP CODE
I.D. NUMBER
831553
ADDRESS
1298 Fifth Avenue
San Rafael CA 99901
4. Type of Committee Complete the applicable sections.
Controlle
• List thelname of each controlling officeholder, candidate, or state measure propCommittee
onent. 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
Nonpartisan Partisan
Primarily Formed Committee 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 MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
party Delauvl
party below)
CHECK ONE
IT OPPOSE
IRT I OPPOSE
FPPC Form 410(August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA
Recipient Committee 117012-11 41,1
INSTRUCTIONS ON REVERSE
Page 9 of 9
COMMITTEE NAME
I.D-NUMBER
San Rafael Police Association Political Action Committee
4. Type of Committee (Continued)
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑x CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
To make political contributions to support and oppose candidates and issues of interest to the San Rafael Police Association.
List additional sponsors on an attachment.
NAME OF SPONSOR
San Rafael Police Association
STREET ADDRESS NO.AND STREEI
Union
CITY
San Rafa
GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE AREA CODE/PHONE
CA 99901 (
❑
Date qualified
5. Termination Requirements By slgning 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