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Home My WebLink AboutForm 460 - Carolina Martin for San Rafael School Board Trustee 2022 10-27-22 AmendmentRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Statement covers period from 111 I IZZ through a I E I z- 1. Type of Recipient Committee: All Committees- Complete Parts 1, 2, 3, and 4. ❑x Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall Q Controlled (Also Complete Part 5) O Sponsored (Also Complete Part5) ❑ General Purpose Committee Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER :OMMITTEE NAME (OR CANDIDATE'S NAME fF NO COMMITTEE) Carolina Martin for San Rafael City Schools District 4 2022 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Antelope CA 95843 ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS ( COVER PAGE E G IEE W Date of election if applicalir OCT (Month, Day, Year) jL II 1 of or Official Use Only 11/°8/2022 ITY CLERK'S OFFI E 2. Type of Statement: ❑x Preelection Statement ❑ Quarterly Statement ❑ Semi-annuat Statement ❑ Special Odd -Year Report ❑ Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 ® Amendment (Explain below) C--, c�JU-#`V1wsc" ?Cc IFA Treasurer(s) NAME OF TREASURER Chelsea Johnson MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE Antelope CA 95843 ( NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY OPTIONAL: FAX / E-MAIL ADDRESS STATE ZIP CODE AREA CODE/PRONE 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true %� Executed on 10/22/2022 Date Executed on 10/22/2022 Data Executed on Date Executed on Date In"A Al nnffile nnm By By By Signature of Controlling Officeholder, Candidate, Stale Measure Proponent By SignatureofControlfing Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) wwwJppe.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Carolina Martin OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Board of Education City of San Rafael District 4 RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP - San Rafael CA 94901 Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME LD NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME J.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE www.netfile.com COVER PAGE - PART 2 1 Page 2 of 31 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded Summary Page to whole dollars. Statement covers period from 01/01/2022 SEE INSTRUCTIONS ON REVERSE through 09/24/2022 Page 3 of 31 NAME OF FILER I.D. NUMBER Carolina Martin for San Rafael City Schools District 4 2022 1449397 Column A Contributions Received TOTALTHIS PERIOD (FROMATTACHED SCHEDULES) 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 25.064.00 6. Payments Made ................... .................................. 2. Loans Received ............. ................................ :........ :. Schedule e, Line 3 9,380.78 0.00 7. Loans Made............................................................. 3. SUBTOTAL CASH CONTRIBUTIONS _....................... Add Lines 1 +2 $ 25, 064.00 8. SUBTOTALCASH PAYMENTS .................................... 4. Nonmonetary Contributions ..................:......::......... Schedule c, Line 3 9,380.78 0.00 9. Accrued Expenses (Unpaid Bills) ............................... 5. TOTAL CONTRIBUTIONS RECEIVED -•- ....................... Add Lines 3+4 $ 25,064.00 10. Nonmonetary Adjustment .......................................... Expenditures Made 6. Payments Made ................... .................................. Schedule E, Line 4 $ 9,380.78 7. Loans Made............................................................. Schedule H, Line 3 0.00 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ 9,380.78 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 4,155.09 10. Nonmonetary Adjustment .......................................... Schedule C, Linea 0.00 11. TOTAL EXPEN DITU RES MADE ................................ AddLinese+9+10 $ 13,535.87 Current Cash Statement 12. Beginning Cash Balance- ......:::.....:...... Previous Summary Page, Line 16 $ 0.00 13. Cash Receipts ............................ :.................. ... Column A, Line 3above 25,064.00 14. Miscellaneous Increases to Cash ........................... Schedule t, Line 4 0.00 15. Cash Payments .................................................. Column A, Line 8above 9, 380.78 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 15,683.22 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule e, Part 2 $ 0.00 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ............. ............ See instructions on reverse $ 0.00 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column 8 above $ 4,155.09 www.netfile.com Column B Calendar Year Summary for Candidates CALENDAR YEAR TOTALTO DATE Running in Both the State Primary and General Elections $ 25,064.00 0.00 $ 25,064.00 0.00 $ 25.064.00 $ 9,380.78 0.00 $ 9,380.78 4,155.09 0.00 $ 13,535.87 To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). 1/1 through 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subjectto Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE NAME OF FILER Carolina Martin for San Rafael City Schools District 4 2022 Amounts may be rounded to whole dollars. Statement covers period from 01/01/2022 through 09/24/2022 SCHEDULEF Page 30 of 31 I.D. NUMBER 1449397 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FIND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF CREDITOR CODE OR ( OUTSTAA NDING ( AMOUNTIN CURRED (c) AMOUNT PAID (d) OUTSTANDING (IF COMMITTEE, ALSO ENTER I D NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD Bank of America WEB 0.00 161.44 0.00 161.44 San Rafael, CA 94901 Bank of America See Schedule G for 0.00 3,993.65 0.00 3,993.65 Individual Payees San Rafael, CA 94901 i * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS $ 0.00$ 4,155.09$ 0.00$ 4,155.09 Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.)...... 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) . 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.)................................................................................................ www.netfile.com INCURRED TOTALS $ 4,155.09 .......................... PAID TOTALS $ 0.00 ................................................ NET 4,155.09 May be a negaUve numher FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov Schedule G Payments Made by an Agent or Independent Amounts may be rounded Contractor (on Behalf of This Committee) to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Carolina Martin for San Rafael City Schools District 4 2022 NAME OF AGENT OR INDEPENDENT CONTRACTOR Bank of America Statement covers period from 01/01/2022 through. 09/24/2022 Page 31 of 31 I.D. NUMBER 1449397 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FIND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)' POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF PAYEE OR CREDITOR CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) 161.44 Political Data Intelligence WEB Long Beach, CA 90806 ScanArt LIT 347.76 Emeryville, CA 94608 ScanArt LIT 3,993.65 Emeryville, CA 94608 Attach additional information on appropriately labeled continuation sheets. * Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. www.netfile.com TOTAL* $ 4,502.85 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov