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HomeMy WebLinkAboutForm 410 - Kate Colin for San Rafael Mayor 2024; InitialStatement of Organization Recipient Committee Statement Type I❑ Initial ❑ Amendment `lot yet qualified or Date qualification threshold met 1 Date qualification threshold met ❑ Termination — See Date of termination GO1t1 1=1 9 JAl 1 ? 223 ITY CLERK'S OFFIC 1. Committee Information I.D. Number 2. Treasurer and Other Principal Officers (if applicable) NAME OF COMMITTEE NAME W TREASURER Kate Colin for San Rafael Mayor 2024 Kate Colin STREET ADDRESS NO P.O. BOX STREET ADDRESS (NO P.O. BOX) CITY CITY STATE ZIP CODE AREA CODE/PHONE Novato CA 94949-5731 ( FULL MAILING ADDRESS (IF DIFFERENT) E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) / ( COUNTY OF DOMICILE I JURISDICTION WHERE COMMITTEE IS ACTIVE Marin County San Rafael Attach additional information on appropriately labeled continuation sheets. For Official Use Only STATE ZIP CODE AREA CODE/PHONE Novato CA 94949-5731 ( NAME OF ASSISTANT TREASURER, IF ANY Nancy L Warren STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Novato CA 94949-5731 ( NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 3. Vera cation I have used all reasonable diligence in preparing OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on DATE nefflie. i9om By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE 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 COMMITTEE NAME Kate Colin for San Rafael Mayor 2024 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION Hank of San Francisco ADDRESS AREA CODE/PHONE (415)744-6700 CITY BANK ACCOUNT NUMBER STATE ZIP CODE 345 California Street #1600 San Francisco CA 94104 4. Type of Committee Complete the applicable sections. I.D. NUMBER 2 of 3 • 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 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 Kate Colin Mayor San Rafael 2024 Nonpartisan X Partisan (list political party below) Nonpartisan Partisan (list political party below) Primarily formed to support or oppose specific candidates or measures in a single election. List below: CAN NAME OR MEASURE(S) FU LL TITLE (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) CHECK ONE T OPPOSE FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fpPC.ca.gov Statement of Organization CALIFOK1111A , 10 Recipient Committee FORM INSTRUCTIONS ON REVERSE Page 3 of 3 COMMITTEE NAM= I,D, NUMBER Kate Colin for San Rafael Mayor 2024 4. Type of Committee (Continued) General Purpose Committee 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 DESCRIPTION OF ACTIVITY List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREETADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE r ❑ Date qualified 5. Termination Requirements By signing 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