HomeMy WebLinkAboutForm 410- Lucia Martel Dow for San Rafael School Board 2022; Termination (State-Digital) 03-10-23a, -
DocuSign Envelope ID: 5lB94C71-AD75-4C56-8BCD-24F0534BA4AA
Statement of Organization Date Stamp CALIFORNIA
Recipient. Committee 111111111 FORM 410
Statement Type ❑ Initial 0 Amendment ❑x Termination - See Part 5 DIGITALLY 3 /--A. r;, 5 y
RECEIVED AND FILED
O Not yet qualified in the office of the California
or Secretary of State
Q Date qualification threshold met Date qualification threshold met Date of termination FEB 13 2023
� R 1 0 2023
1 ! _ 07 _-1, -30 12022 12 / 31t 2022
1. Committee Information I.D. Numberf
1442869 2. Treasurer and Other Principal Offices CITY CLERK'S OFFICE
(if applicable
NAME OF COMMITTEE
Lucia Martel Dow for San Rafael School Board 2022
STREET ADDRESS (NO P.O. BOX)
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 3 R1501 CTION WHE RE COM MITTEE IS ACT IV
Marin County San Rafael
Attach additional information on appropriately labeled continuation sheets.
NAME OF TREASURER
Lucia Martel Dow
STREET ADDRESS (NO P.O. BOX)
CITY
Novato
STATE
CA
ZIP CODE
94949-5731
AREA CODE/PHONE
(
NAME OF ASSISTANT TREASURER, IF ANY
Nancv L Warren
STREET ADDRESS (NO P.O. BOX)
CITY
Novato
STATE
CA
ZIP CODE
94949-5731
AREA CODE/PHONE
(
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/1'HO NE
3. verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury under the laws of the State of
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
DocuSign Envelope ID: 51B94C71-AD75-4C56-8BCD-24F0534BA4AA
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Lucia Martel Dow for San Rafael School Board 2022
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
Bank of San Francisco
ADDRESS
AREA CODE/PHONE
(415)744-6700
CITY
BANK ACCOUNT NUMBER
STATE ZIP CODE
575 Market Street #900 San Francisco CA 94105
4. Type of Committee Complete the applicable sections.
NUMBER
2 of 3
1442869
• 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 CAN MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
Lucia Martel Dow
School Board City of San Rafael
2022
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:
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
ONE
OPPOSE
OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
DocuSign Envelope ID: 51B94C71-AD75-4C56-8BCD-24F0534BA4AA
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Lucia Martel Dow for San Rafael School Board 2022
4. Type of Committee {COrMnuedl
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 OFACTIVITY
List additional sponsors on an attachment.
NAMEOFSPONSOR
GROUP OR AFFILIATION OF SPONSOR
Page 3 of 3
I.D. NUMBER
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
E7iiRUtt I..... UBIi��l------ ►r(Yi ❑
Date qualified
5. Termination Requirements -y sign ing ahe verification, the treasurer, assistant treasurer and/or candidate, Dfficeholder, or proponent certify that all of the following ccndltions 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