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Home My WebLink AboutForm 410 - Faye Bourret for Board of Education 2022APR 2 ' 2022 CITY CLERK'S OFFICE Statement of Organization DaleAAFFW • - CALIFORNIA Recipient Committee FORM 410 Statement Type ®Initial 10 Amendment Q Termination — See Part 5 For OifidAluscoa(Y 1 Not yet qualified or qualification threshold met Dale quellcation threshold met Dale of termination I.D. Number ■ ■ 'ENAME OY TRE41ult 7F.yeB..,ml: for Board of Education - 2022 Faye Bourret ]IMMI ADDREU (N"O. EDkt STREET ADDRESS (NO P.O RDx) CITY STATE OPCOOE AEEA000E/PHONE San Rafael CA 94901 CITY STATE ZIP CODE AREA CODE/PHONE NAME Of ASSISTANT TREASURER, IF ANY San Rafael CA 94901 FULL MAIUNG ADDRESS (IF OIFFERENTI STREET ADDRESS INC P.O BOX) EMAIL ADDRESS IREQUIREDS/FAX (OPTIONAL) CITY STATE 2W CODE AREA CODE/PHONE COUNTY OF DOMICILE IUgI501CTION WHERE C0MMHTEE 15 ACTIVE NAME OF PRINCIPAL OFFICERESI Orange Marin VREUADDRE55 IND P.O. BOX) Attach additional information on appropriately labeled continuation sheets. 3. Verification - CITY STATE ZIP CODE AREA CODE/PHONE I nave use0 alt reasoname of 11 gence In preparing tn(s Staremeni ana to the vest of my xEEDWleage the Information conal neo herein is true and complete. I ce rti ly under penalty of perjury under the laws of the State CINDIDAFE, OR STAFI MEAsu.r i.nPON tau t Executed on WIC By SIGNAI URE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410(August/2018) FPPC Advice: advieernlfooc.c7.gDu (866/275-3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE 'Page Z COMMITTEE NAME r0 NDA(... Faye Bourret for Board of Education - 2022 All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIALINSTITUTION ARECODE/PHONE TAN••CCOUN L h UN OEe .E California Bank & Trust 213-228-1700 AUORESS C'TY SLATE ZIPCODE 550 S Hope St Suite 100 Los Angeles CA 90071 • 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 arts jointly with another controlled committee, list the name and identification number of the other controlled committee. ELECTIVE OFFICE SOUGHT OR IIELU YEAR OF PARTY NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT IIHCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION Faye Bourret San Rafael Board of Education Trustee Area 4 2022 Non, -Von If ParOun Hist pDllRtdl party helaw) Fimpart uin Parnun th$t pCI.IiC.t Pd�:t Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATEIS) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATEISI OFFICE SOUGHT OR HELD OR MEASURE(5I JURISDICTION IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE SUPPORT OPPOSE S UPIORT OPPOSE FPPC Form 410(August/2018) FPPC Advice:(866/275-3772) saar•.v.f pr ra„uy Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE LOM,AnTt t NAME 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 DESCRFTION OF ACTIVITY List additional sponsors on an attachment. NAME OF SPONSOR STREET ADDRESS NO.ANO STREET cry OF SPONSOR STATE ZIP CODE Page 3 iiiiiiiiiiiiiiiiiiiiiillillillillillillilliI Small Contributor Committee Fr" --5 Te frWineiimRecluiremerlt5 evsigwngnmv flflnaon„U�elreasurep assistant treasurer and(�i gndldale;.bffGceholdci�•ot pa ent�c�ifly llia[all of the lohowing Eondlo6ns have heen meri This committee has ceased Ereceive contributionsexpenditures; • 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 910 (August/2018) FPPC Advice: advice@fppc. .rav (866/275-3772) www.fOVt.-c t