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HomeMy WebLinkAboutForm 410 - Maika Llorens Gulati for City Council 2024 (State)R Statement of Organization 21 146 Recipient Committee L Statement Type ® Initial ❑ Amendment Q) Not yet qualified or O Date qualification threshold met Date qualification threshold me' I.D. Number (if applicable) 7Maika MITTEE orens Gulati for San Rafael City Council, District 12024 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIPCODE ' AREACODE/PHONE San Rafael CA 94901 FULL MAILING ADDRESS (IF DIFFERENT) E-MAIL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL) COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Marin I City of San Rafael Attach additional information on appropriately labeled continuation sheets. 8005 ❑ Termination — See Part 5 Date of termination NAME OF TREASURER Maika Llorens Gulati Date Stamp DIGITALLY RECEIVED AND FILED in the office of th California Secretary of Stat MAR 19 2024 STREET ADDRESS (NO P.O. BOX) EMAIL ADDRESS OF TREASURER (REQUIRED) NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED) NAME OF PRINCIPAL OFFICER(S) CITY San Rafael CITY STREET ADDRESS (NO P.O. BOX) CITY EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED) STATE ZIP CODE CA 94901 AREA CODE/PHONE STATE ZIP CODE AREA CODE/PHONE STATE ZIP CODE AREA CODE/PHONE 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 California that the foregoing is true and correct. 3/19/2024 Maika Llorens Gulati Digitally signed by Maika Llorens Gulati Executed on B y Date: 2024.03.19 18:25.40 -07'00' DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER 3/19/2024 Maika Llorens Gulati Digitally signed by Maika Llorens Gulati Executed on By Date: 2024.03. 19 18:29:24 -07'00' DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (Ottober/2023) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization CALIFORNIA' Recipient Committee • - INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER Maika Llorens Gulati for San Rafael City Council, District 12024 • All committees must list the financial institution where the campaign bank account is located and the person(s) authorized to obtain bank records. NAME OF FINANCIAL INSTITUTION AND PERSON(S) AUTHORIZED TO OBTAIN BANK RECORDS AREA CODE/PHONE BANK ACCOUNT NUMBER ADDRESS OF FINANCIAL INSTITUTION CITY STATE ZIP CODE • 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 Nonpartisan Partisan (list political party below) Maika Llorens Gulati City Council Member, City of San Rafael, 2024 ✓ © Nonpartisan Partisan (list political party below) Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURES) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) 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) CHECK ONE SUPPORT OPPOSE SUPPORT OPPOSE FPPC Form 410 (October/2023) FPPC Advice: advicePfppc.ca.gov (866/275-3772) www.fppc.ca.gov