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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 ^ c`1 '� 002 r� n D 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