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Form 497 - Carolina Martin for San Rafael School Board Trustee 2022 10-13-22 2497 Contribution Report Amounts may be rounded to whole dollars. 497 CONTRIBUTION REPORT NAME OF FILER Date of a t• ' • 77 Carolina Martin for San Rafael City Schools District 4 2022 This Filing 10/13 2022 W � V • ' or Official Use Only AREA CODE/PHONE NUMBER I.D. NUMBER (inapplicable) 10/12/2022 San Rafael Federation of Teachers PAC Report No. 1o132ozz-1 ( 1449397 ❑ IND San Rafael, CA 94901 Fx1 COM Committee ID # 1436380 ❑ OTH ❑ Check if Loan ❑ PTY ❑ SCC r Provide interest rale 10/12/2022 San Rafael Teachers Association 1,000.00 ❑ IND Fairfax, CA 94930 ❑ COM ❑x OTH ❑ Check if Loan ❑ PTY ❑ SCC % Provide interest rate ❑ IND ❑ COM ❑ OTH ❑ Check if Loan ❑ PTY ❑ SCC Provide interest rate Reason for Amendment: `Contributor Codes IND— Individual COM — Recipient Committee (otherthan PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC—Small Contributor Committee FPPC Form 497 (Feb/2019) FPPC Advice: advice@fppc.ca.gov (8661275-3772) www.fppc.ca.gov