HomeMy WebLinkAboutForm 460 - Revitalize San Rafael Libraries and Community Center Ad Committee's Top Funder San Rafael Public Library Foundations s. -
•. • -
r - • _-
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from 01/01/24
through 03/31/24
1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4.
❑ Officeholder, Candidate Controlled Committee ® Primarily Formed Ballot Measure
O State Candidate Election Committee Committee
0 Recall 0 Controlled
(Also Complete Part5) 0 Sponsored
(Also Complete Part 6)
❑ General Purpose Committee
0 Sponsored ❑ Primarily Formed Candidate/
0 Small Contributor Committee Officeholder Committee
0 Political Party/Central Committee (Also Complete Part7)
3. Committee Information
I.D. NUMBER
Revitalize San Rafael Libraries & Community Center
Ad Committee's top funder San Rafael Public Library Foundation
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA 94901
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA 94912
OPTIONAL: FAX / E-MAIL ADDRESS
CALIFORNIA
00
n r^ L� Page 1 of 19
Date of election if a a le:
(Month, Day, ar) For Official Use Only
r
November 5, 20
' CITY CLERKS OFFICE
❑ Preelection Statement F71 Quarterly Statement
❑ Semi-annual Statement ❑ Special Odd -Year Report
❑ Termination Statement
(Also file a Form 410 Termination)
❑ Amendment (Explain below)
NAME OF TREASURER
Charles H. Stuckey
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael CA 94901
NAME OF ASSISTANT TREASURER, IF ANY
Charles Litchfield
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael
OPTIONAL: FAX / E-MAIL ADDRESS
CA 94901
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
Measure Proponent or Responsible Officer of Sponsor
Executed on By
Date Signature of Controlling Officeholder, Candidate, State Measure Proponent
Executed on By
Date Signature of Controlling Officeholder, Candidate, State Measure Proponent
FPPC Form 460(3an/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENTIAL/BUSINESS ADDRESS (NO-ANDSTREET) CITY STATE ZIP
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 I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
0 YES E] NO
COMMITTEE ADDRESS STREETAIDDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
[—] YES ❑ NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
COVER PAGE - PART 2
Page 2 of 19
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
Revitalize San Rafael Libraries and Community Center ad Commitee's Top Funded
BALLOT NO. OR LETTER JURISDICTION I San Rafael ®SUPPORT
M 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 Listnames 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
E:1 OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD❑
SUPPORT
❑ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
El SUPPORT
Ej OPPOSE
CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary
FPPC Form 460 (1an/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Campaign Disclosure Statement Amounts may be rounded
to whole dollars.
Summary Page
SEE INSTRUCTIONS owREVERSE
NAME opFILER
Revitalize San Rafael Libraries &Communitv Center AdCommittee's TmFunderSan Rafael Public Library Foundation
Column
Contributions Received
TOTAL THIS PERIOD
(FROM ATTACHED nnoEDvLEn
1. K�one1oryConUibu�una-----------------
oo�^m�A.Lmox
$ 9�V}�
2. Loans Received ---------------------.
m�ouu��Lmex
5V0O
1 SUBTOTAL CASH CONTRIBUTIONS ..............................
Add Lines I+x
$ 101833
4. NonmonetaryContribudnns .--------------.
Schedule C, Line
101033
O. Peymen�K8ude---------------------
n�ed��cmo4
$ 99d2l
7. Loans Made ........ ...... ............................. __-..........
Schedule uLine 3
8. SUBTOTAL CASH PAYMENTS ..... ........................
........ Add Lines o~r
$ 99621
0. AnomedExpenses (Unpaid B0o--------------o�ouu��Lmno
2l99
1[LNonmunotaryAdjustment .........................................................
Schedule C. Line
101820
12.Beginning Cash Balanoe.......................... Previous Summary mm puoo�o
$ 0
13.Cash Reue�o-------------------' mmmm�Lmoxauu�
1010�3
14.Miscellaneous Increases 0oCash .................................. Schedule 1,Line 4
15.Cash Peyme�s------------------- onmmn�Lmou�o�
99uzl
18.GWD{NG CASH BALANCE .................. Add Lines 12~m�then subtract
$ 1412
ffthis matermination statement, Line /nmust bezero.
17. LOAN GUARANTEES RECEIVED ..... ......................... Schedule B, Pall
$
Cash Equivalents and Outstanding Debts
7199
Column
o^LEmDAR,s^e
TOTAL TO DATE
96033
5000
$ 101033
$
101033
_____
99621
'
990%l
____
2199
$
101820
�����
Tucalculate Column e\
add amounts mColumn
xtothe corresponding
amounts from Column g
ufyour last report. some
� amounts inColumn xmay
� »enegative fiyuresthat
should uesubtracted from
� previous period amounts. If
this isthe first report being
� filed for this calendar year,
� only carry over the amounts
� from Uneau. 7. and 8 (if
SUMMARYPAGE
Statement covers period
from Ol/Ol/24
/ 3 l9
through �8l/� | ��---�__'I.D. NUMBER
ooContribmvns
Received $_____-_--- $
| e1. Expenditures
| Made $-_____-___ $
Candidates
oa Cumulative Expenditures Made*
(If Subject mVoluntary Expenditure Limit)
Date orElection Total ozDate
| Amounts in this section may be different from amounts
reported in Column B.
FppCForm 46DUao/2n1*}
FPPC«dvice: (866/275-3772)
Schedule A Amounts may be rounded SCHEDULE A
Monetary Contributions Received to wnow dollars.
Statement covers period
®- ,
from 01/01/24
® -
through 03/31/24
Page 4 of 19
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER I.D. NUMBER
Revitalize San Rafael Libraries & Community Center, Ad Committee's Top Funder San Rafael Public Library Foundation 1467556
FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION
DATE CONTRIBUTOR OCCUPATION AND EMPLOYER
CONTRIBUTOR RECEIVED THIS CALENDAR YEAR TO DATE
RECEIVED CODE Y (IF SELF-EMPLOYED, ENTER NAME
(IF COMMITTEE, ALSO ENTER I.D. NUMBER) OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED)
❑ IND
Various
San Rafael Public Library Foundation 1467937
® COM
89313
89313
n/a
❑ OTH
San Rafael, CA 94901
❑ PTY
❑ SCC
® IND
03/12/24
David Layne
❑ COM
Retired
50.
50.
n/a
❑ OTH
San Rafael, CA 94903
❑ PTY
❑ SCC
® IND
03/12/24
Sarah Forsman
❑ COM
Retired
25.
25
n/a
❑ OTH
San Rafael, CA 94901
❑ PTY
❑ SCC
V IND
03/12/24
Marlene J. Casissa
El
Retired
20.
20..
n/a
I ❑ OTH
San Rafael, CA 94903
❑ PTY
❑ SCC
® IND
03/19/24
Pam Dixon
❑ COM
Retired
500.
500.
n/a
❑ OTH
San Rafael, CA 94901
❑ PTY
❑ SCC
SUBTOTAL $ 89908
1. Amount received this period — itemized monetary contributions. 96033.00
(include all Schedule A subtotals.).........................................................................................................$
2. Amount received this period — unitemized monetary contributions of less than $100 ...........................$
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)................
TOTAL $ 96033.00
*Contributor Codes 1
IND — Individual 1
COM — Recipient Committee i
(other than PTY or SCC)
OTH — Other (e.g., business entity)
PTY — Political Party
SCC — Small Contributor Committee
FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE (CONT.)
Monetary Contributions Received to whole dollars.
Statement covers period
from01/01/24
so=
through 03131/24
Page 5 of 19
NAME OF FILER I.D. NUMBER
Revitalize San Rafael Libraries & Community Center Ad Committee's Top Funder San Rafael Public Library Foundation 1467556
FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION
DATE CONTRIBUTOR
OCCUPATION AND EMPLOYER
CONTRIBUTOR * RECEIVED THIS CALENDAR YEAR TO DATE
RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME)
(IF COMMITTEE, ALSO ENTER I.D. NUMBER) OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED)
® IND
03/19/24
Dr. Michael Parrett
El COM
Dentist
25
25
❑ OTH
Dr. Michael Parrett
San Rafael, CA 94901
❑ PTY
❑ SCC
® IND
03/19/24
Charles Litchfield
❑ COM
Real Estate Broker
1000
1000
❑ OTH
Litchfield Brokers
San Rafael, CA 9901
❑ PTY
Ej SCC
®IND
03/19/24
Kate Colin
El COM
Mayor
1000
1000
❑ OTH
City of San Rafael
San Rafael, CA 9901
❑ PTY
El SCC
®IND
03/18/24
Joseph O'Hehir
El COM
Retired
1000
1000
❑ OTH
San Rafael, CA 94901
❑ PTY
❑ SCC
®IND
03/19/24
Gary Ragghianti
❑ COM
Attorney
1000
1000
❑ OTH
Ragghianti, Freitas, LLP
San Rafael, CA 94901
❑ PTY
El SCC
SUBTOTAL $ 4025
*Contributor Codes
IND — Individual
COM — Recipient Committee
(other than PTY or SCC)
OTH — Other (e.g., business entity)
PTY — Political Party
SCC — Small Contributor Committee
FPPC Form 460 (Dan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE (CONT.)
Monetary Contributions Deceived to whole dollars.
Statement covers period
®
from 01/01/24
! -
through 03131/24
Page 6 of 19
NAME OF FILER I.D. NUMBER
Revitalize San Rafael Libraries & Community Center, Ad Committee's Top Funder San Rafael Public Library Foundation 1467556
FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION
DATE CONTRIBUTOR OCCUPATION AND EMPLOYER
CONTRIBUTOR * RECEIVED THIS CALENDAR YEAR TO DATE
RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME)
(IF COMMITTEE, ALSO ENTER LD. NUMBER) OF BUSINESS) I PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED)
® IND
03/19/24
Cheryl Lentini
❑ COM
Architect
500
500
❑ OTH
C.A. Lentini Design
San Rafael, CA 94901
❑ PTY
❑ SCC
®IND
03/20/24
Barbara Squires
El COM
Administrative Asst.
100
100
❑ OTH
The Busy B
Greenbrae, CA 94904
❑ PTY
❑ SCC
®IND
03/27/24
Charles H. Stuckey
El COM
Retired
1000
i000
❑ OTH
San Rafael, CA 94901
❑ PTY
❑ SCC
®IND
02/07/24
Barbara Heller
El COM
Retired
500
500
❑ OTH
San Rafael, CA 94903
❑ PTY
❑ SCC
® IND
❑ COM
❑ OTH
❑ PTY
SCC
SUBTOTAL $ 2100
"Contributor Codes
IND — Individual
COM — Recipient Committee
(other than PTY or SCC)
OTH — Other (e.g., business entity)
PTY — Political Party
SCC — Small Contributor Committee
n» ...,sr k ..,...,.ateA
SCHEDULE B - PART 1
Schedule B — Part 1
Loans Received
to whole dollars. ~vµ
Statement covers period
from 01/01/24
o
• -
SEE INSTRUCTIONS ON REVERSE
through 03/31/24
Page 7
of 19
NAME OF FILER
I.D. NUMBER
Revitalize San Rafael Libraries & Community
Center Ad Committee's Top Funder
San Rafael Public Library Foundation
1467556
FULL NAME, STREET ADDRESS AND ZIP CODE
OF LENDER
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
( IF SELF-EMPLOYED, ENTER
OF BUSINESS)
a ) c e
OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST
BALANCE RECEIVED THIS OR FORGIVEN BALANCE AT PAID THIS
BEGINNING THISNAME
PERIOD PERIOD THIS PERIOD * CLOPERIOD HIS PERIOD
ORIGINAL
AMOUNT OF
LOAN
g
CUMULATIVE
CONTRIBUTIONS
TO DATE
❑ PAID
CALENDAR YEAR
Charles Litchfield
Real Estate Broker
$ 0
$ 5000
0
$ 5000
$ 6000
❑ FORGIVEN
$ 0
PER ELECTION *
$ n/a
San Rafael, CA 94901
Litchfield Brokers
0
$
5000
$
12/31/24
RATE
$ 0
03/26/24
DATE DUE
DATE INCURRED
T ® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
❑ PAID
CALENDAR YEAR
$
$
%
$
$
❑ FORGIVEN
PER ELECTION**
RATE
t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
$
$
$
S
$
DATE DUE
DATE INCURRED
❑ PAID
CALENDAR YEAR
❑ FORGIVEN
PER ELECTION"
RATE
t ❑ IND ElCOM [IOTH [IPTY ElSCC
$
$
$
$
$
DATE DUE
DATE INCURRED
SUBTOTALS $ 5000 $ 0
$ 5000 $ 0
1. Loans received this period..............................................................................
(Total Column (b) plus unitemized loans of less than $100.)
2. Loans paid or forgiven this period...................................................................
(Total Column (c) plus loans under $100 paid or forgiven.)
(include loans paid by a third party that are also itemized on Schedule A.)
3. Net change this period. (Subtract Line 2 from Line 1.).................................
Enter the net here and on the Summary Page, Column A, Line 2.
*Amounts forgiven or paid by another party also must be reported on Schedule A.
** If required.
...................................... $
...................................... $
5000
.... NET $ 5000
(May be a negative number)
(Enter (a) on Schedule E, Line 3)
tContributor Codes
IND — Individual
COM — Recipient Committee
(other than PTY or SCC)
OTH — Other (e.g., business entity)
PTY — Political Party
SCC — Small Contributor Committee
FPPC Form 460 (!an/2036))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SCHEDULE B - PART 2
Schedule B _ Part 2 Amounts may De rounaea
Statement covers period
to whole dollars.
Loan Guarantors
01/01/24
s
from
through 03/31/24
Page 8 of 19
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER I.D. NUMBER
Revitalize San Rafael Libraries & Community Center Ad Committee's Top Funder San Rafael Public Library Foundation 1467556
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT BALANCE
OCCUPATION AND EMPLOYER CUMULATIVE
CONTRIBUTOR LOAN GUARANTEED
E OUTSTANDING
CODE (IF SELF-EMPLOYED, ENTER THIS PERIOD TO DATE TO DATE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS)
LENDER
CALENDAR YEAR
None
❑ IND
0
0
0
❑ COM
$
❑ OTH
DATE
PER ELECTION
❑ PTY
(IF REQUIRED)
❑ SCC
$
LENDER
CALENDAR YEAR
❑IND
0
0
0
❑ COM
s
❑ OTH
DATE
PER ELECTION
❑ PTY
(IF REQUIRED)
❑ SCC
g
CALENDAR YEAR
LENDER
❑ IND
0
0
0
❑ COM
❑ OTH
PER ELECTION
❑ PTY
DATE
(IF REQUIRED)
❑ SCC
LENDER
CALENDAR YEAR
❑ IND
0
❑ COM
0
$
0
❑ OTH
DATE
PER ELECTION
❑ PTY
(IF REQUIRED)
❑ SCC
y
Enter on
SUBTOTAL $ 0 Summary Page,
Line 17 only.
FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Rr°ltarI1 ol0 (a Amounts may be rounded SCHEDULE C
®tIIP onetary Contributions Received t® WnVoe uV':dam.
Statement covers period
®I_
from 01/01/24
® -
through 03/31/24
9
page of 19
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER I.D. NUMBER
Revitalize San Rafael Libraries & Community Center Ad Committee's Top Funder San Rafael Public Library Foundation 1467556
FULL NAMESTREET ADDRESS AND IF AN INDIVIDUAL, ENTER AMOUNT! CUMULATIVE TO PER ELECTION
,
DATE CONTRIBUTOR OCCUPATION AND EMPLOYER DESCRIPTION OF DATE
FAIR MARKET TO DATE
ZIP CODE OF CONTRIBUTOR
RECEIVED CODE (IF SELF-EMPLOYED, ENTER GOODS OR SERVICES VALUE CALENDAR YEAR (IF REQUIRED)
(IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) (JAN 1 - DEC 31)
❑ IND
None
❑ COM
n/a
❑ OTH
❑ PTY
❑ SCC
❑IND
❑ COM
n/a
❑ OTH
❑ PTY
❑ SCC
❑ IND
n/a
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
n/a
❑ OTH
❑ PTY
❑ SCC
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 0
Schedule C Summery
1. Amount received this period — itemized nonmonetary contributions.
(Include all Schedule C subtotals.) ........................................ .............................................................................. $
2. Amount received this period — uniternized nonmonetary contributions of less than $100 ................
3. Total nonmonetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ....
I
Contributor Codes
IND - Individual
COM - Recipient Committee
(other than PTY or SCC)
OTH - Other (e.g., business entity)
PTY - Political Party
SCC - Small Contributor Committee
FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SCHEDULE D
Summary of Expenditures
Amounts may be rounded
Statement covers period
Supporting/Opposing Other
to whole dollars.
01/01/24
Candidates, Measures and Committees
from
through 03/31/24
page 10 of 19
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
I.D. NUMBER
Revitalize San Rafael Libraries & Community Center Ad Committee's
Top Funder San Rafael Public Library Foundation
1467556
NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR
DESCRIPTION
AMOUNT THIS
CUMULATIVE TO DATE PER ELECTION
DATE MEASURE NUMBER OR LETTER AND JURISDICTION,
TYPE OF PAYMENT
(IF REQUIRED)
PERIOD
CALENDAR YEAR TO DATE
OR COMMITTEE
JAN. 1 -DEC. 31 (IF REQUIRED)
()
❑
Monetary
None
Contribution
0
0
n/a
❑
Nonmonetary
Contribution
❑
Independent
❑ Support ❑ Oppose
Expenditure
❑
Monetary
Contribution
0
0
n/a
❑
Nonmonetary
Contribution
❑
Independent
❑ Support ❑ Oppose
Expenditure
❑
Monetary
Contribution
0
0
n/a
❑
Nonmonetary
Contribution
❑
Independent
❑ Support ❑ Oppose
Expenditure
SUBTOTAL
$ 0
-♦ i
1. Itemized contributions and independent expenditures made this period. (include all Schedule D subtotals.).....................................................
2. Unitemized contributions and independent expenditures made this period of under$100..................................................................................
3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) .......... TOTAL
0
0
$ 0
FPPC Form 460 (Jan/2016)y
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
wwwJppc.ca.gov
Schedule D
j%-PUllLl11Ut1LIU11 Q11VICIL) Amounts May De rounueo
SCHEDULE D (CONT.)
Summary of Expenditures to whole dollars.
Statement covers period
Supporting/Opposing Other
01/01/24
0
from
Candidates, Measures and Committees
through 03/31/24
19
Page Of
NAME OF FILER I.D. NUMBER
Revitalize San Rafael Libraries & Community Center Ad Committee's Top Funder San Rafael Public Library Foundation 1467556
NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE PER ELECTION
DATE MEASURE NUMBER OR LETTER AND JURISDICTION, TYPE OF PAYMENT (IF REQUIRED) PERIOD CALENDAR YEAR TO DATE
OR COMMITTEE (JAN. 1 -DEC. 31) (IF REQUIRED)
E] Monetary
Contribution
0
0
n/a
rl Nonmonetary
Contribution
E] independent
❑ Support ❑ Oppose
Expenditure
F1 Monetary
Contribution
0
0
n/a
❑ Nonmonetary
Contribution
❑ Independent
El support El oppose
Expenditure
❑ Monetary
Contribution
0
0
n/a
❑ Nonmonetary
Contribution
❑ independent
El Support 13 Oppose
Expenditure
rl Monetary
Contribution
0
0
n/a
❑ Nonmonetary
Contribution
❑ Independent
El Support 11 Oppose
Expenditure
SUBTOTAL $ 0
FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule
SEE INSTRUCTIONS ON REVERSE
Amounts may be rounded
to whole dollars.
Revitalize San Rafael Libraries & Community Center Ad Committee's Top Funder San Rafael Public Library Foundation
Statement covers period
from 01/01/24
through 03/31/24
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
SCHEDULE E
:ALIFQKNIA 4 V
FORM V V
P �� ��,
I,D. NUMBER
1467556
CMP
campaign paraphernalia/misc.
MBR
member communications
RAID
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
FND
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 PAYEE
CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
California Secretary of State FIL 50,
Sacramento, CA 95814
Neilsen Merkhamer et a1 PRO 11765.00
San Rafael, CA 94901
Olsen Petition Management, LLC PET Signature gathering to put measure on ballot 75000.00
Hanford, CA 93230
Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 86815.00
1. Itemized payments made this period. (Include all Schedule E subtotals.) ...........................................
2. Unitemized payments made this period of under$100..............................................................................................................................
3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).).................................................................
4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.)...........................
99621
............ $
............ $
0
............ $ 0
TOTAL $ 99621
FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule
(Continuation Sheet)
Amounts may be rounded
to whole dollars.
SCHEDULE E (CONT.)
Statement covers period
, •Paymentsade
m
01/01/24i
ffrom
through 03/31/24
Page 13 of 19
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
I.D. NUMBER
Revitalize San Rafael Libraries & Community Center Ad Committee's
Top Funder San Rafael Public Library Foundation
1467556
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
FND 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 PAYEE
CODE OR DESCRIPTION OF PAYMENT
AMOUNT PAID
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
Team CivX
CNS
5000
Orinda, CA 9563
eFundraising Connections
Credit Card discounts on donation made by credit cards
171
Sacramento, CA 95816
The Monaco Group
Printing
285
Santa Ana, CA 92705
I
San Francisco Edit
Proofreading
1381
San Francisco, CA 9109
Autumn Press
Printing Envelopes
2934
Berkeley, CA 94710
I
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 12340
FPPC Form 460 (Jan 2016))
FPPC Advice. advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule
t •
Payments •
Amounts may be rounded
to whole dollars.
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Revitalize San Rafael Libraries & Community Center Ad Committee's Top Funder San Rafael Public Library Foundation
COGS: If one of the following codes accurately describes the
CMP
campaign paraphernalia/misc.
MBR
CNS
campaign consultants
MTG
CTB
contribution (explain nonmonetary)'
OFC
CVC
civic donations
PET
FIL
candidate filing/ballot fees
PHO
FND
fundraising events
POL
IND
independent expenditure supporting/opposing others (explain)"
POS
LEG
legal defense
PRO
LIT
campaign literature and mailings
PRT
payment, you may enter the code
member communications
meetings and appearances
office expenses
petition circulating
phone banks
polling and survey research
postage, delivery and messenger services
professional services (legal, accounting)
print ads
itement covers
01/01/24
from
through 03/31/24
Otherwise, describe the payment.
SCHEDULE E (CONT.)
Page 14 of 19
I.D. NUMBER
167556
RAD radio airtime and production costs
RFD returned contributions
SAL campaign workers' salaries
TEL t.v. or cable airtime and production costs
TRC candidate travel, lodging, and meals
TRS staff/spouse travel, lodging, and meals
TSF transfer between committees of the same candidate/sponsor
VOT voter registration
WEB information technology costs (internet, e-mail)
NAME AND ADDRESS OF PAYEE
CODE OR DESCRIPTION OF PAYMENT
AMOUNT PAID
(IF COMMITTEE, ALSO ENTER LD, NUMBER)
United States Postal Service
Post Office Box
388
San Rafael, CA 94901
Deluxe Check
Printing Checks
28
Bank of Mann San Rafael, CA 94901
Internal Revenue Service
Filing under 501(c)(4)
50
Cinncinnati, OH 45999-0023
0
0
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 466
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SCHEDULEF
Schedule r •--•
to whole dollars.
Accrued Expenses (Unpaid
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Revitalize San Rafael Libraries & Community Center Ad Committee's Top Funder San Rafael Public Library Foundation
CODES: If one of the following codes accurately describes the payment, you may enter the code.
CMP
campaign paraphernalia/misc.
MBR
member communications
CNS
campaign consultants
MTG
meetings and appearances
CTB
contribution (explain nonmonetary)*
OFC
office expenses
CVC
civic donations
PET
petition circulating
FIL
candidate filing/ballot fees
PHO
phone banks
FND
fundraising events
POL
polling and survey research
IND
independent expenditure supporting/opposing others (explain)*
POS
postage, delivery and messenger services
LEG
legal defense
PRO
professional services (legal, accounting)
LIT
campaign literature and mailings
PRT
print ads
Statement covers period
from 01/01/24
through 03/31/24
Otherwise, describe the payment.
Page 15 of 19
I.D. NUMBER
1467556
RAD radio airtime and production costs
RFD returned contributions
SAL campaign workers' salaries
TEL t.v. or cable airtime and production costs
TRC candidate travel, lodging, and meals
TRS staff/spouse travel, lodging, and meals
TSF transfer between committees of the same candidate/sponsor
VOT voter registration
WEB information technology costs (internet, e-mail)
(a)
(b)
(c)
(d)
NAME AND ADDRESS OF CREDITOR
CODE OR
OUTSTANDING
AMOUNT INCURRED
AMOUNT PAID
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
Neilsen Merkharner et al
PRO
0
1500
0
1500
San Rafael, CA 94901
The Monaco Group
Printing
0
699
0
699
Santa Ana, CA 92705
I
* Payments that are contributions or independent expenditures must also be SUBTOTALS $ $ 2198.62 $ 0 $ 2199
summarized on Schedule D.
Schedule F Summary
1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for 2199
accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ............................................INCURRED TOTALS $
2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on 0
accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under$100.).................................. PAID TOTALS $
3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and 2199
on the Summary Page, Column A, Line 9.)............................................................................................ ., ... ............. NET $
May be a negative number
FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule
(Continuation
Accrued Expenses (Unpaid
Amounts may be rounded
to whole dollars.
Statement covers period
from 01/01/24
SCHEDULE F (CONT.)
l through 03/31/24
Page 16 of 19
NAME OF FILER
I.D. NUMBER
Revitalize San Rafael Libraries & Community Center Ad Committee's Top Funder San Rafael Public Library Foundation
1467556
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
FND
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 CREDITOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE OR
DESCRIPTION OF PAYMENT
(a)
OUTSTANDING
BALANCE BEGINNING
OF THIS PERIOD
(h)
AMOUNT INCURRED
THIS PERIOD
(c)
AMOUNT PAID
THIS PERIOD
(ALSO REPORT ON E)
(d)
OUTSTANDING
BALANCE AT CLOSE
OF THIS PERIOD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SUBTOTALS $ 0 $ 0 $ 0 $ 0
FPPC Form 460 (3an/2026))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
6-.N ro-W-W
SCHEDULE G
Payments Made by an Agent or Independent Amounts may be rounded statement covers perioa
Contractor (on Behalf of This Committee) to whole dollars. from 01/01/24 J"
03/31/24 1719
SEE INSTRUCTIONS ON REVERSE through Page of
NAME OF FILER I.D. NUMBER
Revitalize San Rafael Libraries & Community Center Ad Committee's Top Funder San Rafael Public Library Foundation 1467556
NAME OF AGENT OR INDEPENDENT CONTRACTOR
None
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
tv. or cable airtime and production costs
FIL
candidate filing/ballot fees
PHO
phone banks
TRC
candidate travel, lodging, and meals
FND
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
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE OR DESCRIPTION OF PAYMENT
AMOUNT PAID
0
0
0
0
Attach additional information an appropriately labeled continuation sheets. TOTAL* $ o
* Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or FPPC Form 460 (Jan/2016))
independent contractor as reported on Schedule E. FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SCHEDULE H
Schedule H
Amounts may be rounded
Statement covers period
� ®-
to whole dollars.
,
01/01/24
-
LoanS Made to Others*
from
A
F
through 03/31/24
Page 18
of 1
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
I.D. NUMBER
Revitalize San Rafael Libraries & Community Center Ad Committee's Top Funder San Rafael Public Library Foundation
1467556
IF AN INDIVIDUAL, ENTER
FULL NAME, STREET ADDRESS AND ZIP CODE
OCCUPATION AND EMPLOYER
ta)
OUTSTANDING AMOUNT
c
REPAYMENT OR
OUTSTANDING
e
(
ORIGINAL
S
CUMULATIVE
OF RECIPIENT
(IF SELF-EMPLOYED, ENTER
BALANCE LOANED THIS
BEGINNING THIS
FORGIVENESS
BALANCE AT
CLOSE OF THIS
INTEREST
RECEIVED
AMOUNT OF
LOANS
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
NAME OF BUSINESS)
PERIOD
FRIODNone❑
THIS PERIOD*
pFRIon
LOAN
TO DATE
PAID
CALENDARYEAR
$ 0
$ 0
$ 0
$0
r
RATE
FORGIVEN
PER ELECTION"
0
$
0
$
$°
$0
$
DATE DUE
DATE INCURRED
PAID
CALENDAR YEAR
$ 0
$ 0
%
$ 0
$ 0
RATE
❑ FORGIVEN
PER ELECTION
0
$
0
$
I$0
$0
$
DATE DUE
DATE INCURRED
`Loans that are contributions to another candidate or committee must
also be summarized on Schedule D. Loans forgiven must also be
reported on Schedule E.
SUBTOTALS
$ 0
$ 0
$ 0
$ 0
(Enter (e) on
Schedule I, Line 3)
1. Loans made this period....................................................................................
(Total Column (b) plus unitemized loans of less than $100.)
2. Payments received on loans............................................................................
(Total Column (c) plus unitemized payments of less than $100.)
3. Net change this period. (Subtract Line 2 from Line 1.).....................................
(Enter the net here and on the Summary Page, Column A, Line 7.)
0
........................................................$ —
0
...........................................................$ —
.............. NET $ 0
(May be a negative number)
*If Required
FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
waww.fppc.ca.gov
SCHFDULFI
Miscellaneous Increases to Cash to whole dollars.
statement covers period
01/01 /24
"
from
through 03/3I/24
Page 19 of 19
9
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
I.D. NUMBER
Revitalize San Rafael Libraries & Community Center Ad Committee's Top Funder San Rafael Public Library Foundation
1467556
DATE FULL NAME AND ADDRESS OF SOURCE
AMOUNT OF
DESCRIPTION OF RECEIPT
RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER)
INCREASE TO CASH
none
0
0
0
0
0
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 0
Schedule ummary
1. Itemized increases to cash this period . ........................................... ................................................................................ $ 0
2. Unitemized increases to cash of under $100 this period....................................................... ............ ............
3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) .....................
4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the
SummaryPage, Line 14.)........................................................................................................................
...........$ 0
0
$—
FPPC Form 460 (Jan/2036))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov