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Form 470 - Maribeth Bushey (exceeded)Officeholder and Candidate Campaign Statement Form 470 Supplement SEE INSTRUCTIONS ON REVERSE ❑ Amendment (Explain Below) This form is written notification that the officeholder/candidate listed below has received contributions totaling $2,000 or more or made expenditures of $2,000 or more during the calendar year. 1. Officeholder or Candidate Information NAME OF OFFICEHOLDER OR CANDIDATE Maribeth Bushey STREETADDRESS STATE ZIP CODE San Rafael CA 94901 AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX / E-MAIL ADDRESS 2. Office Sought City Council, City of San Rafael (IFAPPLICABLE) 3 S E P 1 2 2022 ITY CLERK'S OFF! E November 8, 2022 3. Date Contributions Totaling $2,000 or More Were Received or Date Expenditures of $2,000 or More Were Made 09/10/2022 (MONTH, DAY, YEAR) For Official Use Only FPPC Form 470/470 Supplement (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov