~ecip,ient Cmmittee Campaign Statement Cver Page Date f electin if applicable ~ (Mnth, Day, Year) frm thrugh 1. Type f Recipient Cmmittee: I!lI 12/31/17 2. Type f Statement: All Cmmittees - Cmplete Parts 1,2,3, and 4. Officehlder, Candidate Cntrlled Cmmittee State Candidate Electin Cmmittee Recall Preelectin Statement ~ Semi-annual Statement Terminatin Statement (Als file a Frm 410 Terminatin) (Als Cmplete Pari 6) General Purpse Cmmittee Spnsred Small Cntributr Cmmittee Plitical Party/Central Cmmittee Primarily Frmed Candidatel Officehlder Cmmittee 3. Cmmittee Infrmatin Special Odd-Year Reprt Amendment (Explain belw) Treasurer(s) 1376443 NAME IF NO fr Mayr 2015 MAILING ADDRESS San Rafael Ca 94903 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX Quarterly Statement (N Cmplete Part 7) COMMITIEE NAME (OR Primarily Frmed Ballt Measure Cmmittee Cntrlled Spnsred (Als Cmplete Parl 5) 711/17 MAILING ADDRESS OPTIONAL: FAX I E-MAIL ADDRESS OPTIONAL: FAX I E-MAIL ADDRESS 4. Verificatin I have used all reasnable diligence in preparing and reviewing this statement and t the best f my knwledge the infrmatin cntained herein and in the attached schedules is true and cmplete. certify under penalty f perjury under the laws f the State f Califrnia that the freging is true and crrect. Executed n Executed n Executed n Executed n - Dale 1/23/17 Date - - Dale Dale ~ By By., = I _._...~LI1~~ O J ~...... a. _ J. _. ~.," "m ~_.~ ~n~'~_.,-,_ " u,.. _ ~ n_u. By----------~~~~~~~?W~~~~~~~~~~~~~---------- Signature f Cntrlling Officehlder, Candidate, State Measare Prpnent FPPC Frm 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gv (866/275-3772)
COVER PAGE - PART 2 Recipient Cmmittee Campaign Statement Cver Page - Part 2 6. Primarily Frmed Ballt Measure Cmmittee 5. Officehlder r Candidate Cntrlled Cmmittee NAME OF BALLOT MEASURE BALLOT NO. OR LEITER (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) SUPPORT OPPOSE JURISDICTION Mayr - City f San Rafael RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) San Rafael ZIP Ca 94903 Related Cmmittees Nt Included in this Statement: List any cmmittees nt included in this statement that are cntrlled by yu r are primarily frmed t receive cntributins r make expenditures n behalf f yur candidacy. COMMIITEE NAME I.D. NUMBER CO NTROLLED COMMITTEE? DYES COMMIITEE AD DRESS COMMIITEE NAME CONTROLLED COMMIITEE? DYES COMMIITEE ADDRESS NO Identify the cntrlling fficehlder, candidate, r state measure prpnent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT DISTRICT NO. IF ANY 1. Primarily Frmed Candidate/Officehlder Cmmittee Listnamesf fficehlder(s) r candidate(s) fr which this cmmittee is primarily frmed. SUPPORT OPPOSE SUPPORT OPPOSE ONO SUPPORT OPPOSE SUPPORT OPPOSE Attach cntinuatin sheets if necessary FPPC Frm 460 (Jan/20I6) FPPC Advice: advice@fppc.ca.gv (866/275-3172) www.fppc.ca.gv
Campaign Disclsure Statement Summary Page Amunts may be runded t whle dllars. frm 7/1/17 SUMMARY PAGE thrugh 12/31/17 Page 3 f 5 _ 1376443 Cntributins Received ClumnA TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) Clumn B CALENDAR YEAR TOTAL TO DATE Calendar Year Summary fr Candidates Running in Bth the State Primary and General Electins 1. Mnetary Cntributins......... Schedule A, Line 3 1/1 thrugh 6/30 7/1 t Date 2. Lans Received............ Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS... Add Lines 1 + 2 20. Cntributins Received ----- 4. Nnmnetary Cntributins... Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED............. Add Lines 3 + 4 21. Expenditures Made ---- - Expenditures Made 6. Payments Made.............................. Schedule E, Line 4 Expenditure limit Summary fr State Candidates 7. Lans Made... Schedule H, Line 3 8. SUBTOTAL CASH PAyMENTS...... Add Lines 6 + 7 22. Cumulative Expenditures Made* (If Subject t Vluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills)...... Schedule F. Line 3 10. Nnmnetary Adjustment...... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE... Add Lines 8 + 9 + 10 Date f Electin (mm/dd/yy) _--...J/~ Ttal t Date ---- Current Cash Statement 12. Beginning Cash Balance Previus Summary Page, Line 16 13. Cash Receipts Clumn A, Line 3 abve 14. Miscellaneus Increases t Cash Schedule I, Line 4 15. Cash Payments Clumn A, Line 8 abve 16. ENDING CASH BALANCE... Add Lines 12 + 13 + 14. then subtract Line 15 If this is a terminatin statement, Line 16 must be zer. 17. LOAN GUARANTEES RECEIVED......... Schedule B, Part 2 Cash Equivalents and Outstanding Debts 18. Cash Equivalents... See instructins n reverse 6750 5050 5050 T calculate Clumn B, add amunts in Clumn A t the crrespnding amunts frm Clumn B f yur last reprt. Sme amunts in Clumn A may be negative figures that shuld be subtracted frm previus perid amunts. If this is the first reprt being filed fr this calendar year, nly carry ver the amunts frm Lines 2,7, and 9 (if any). ~~-- - --- 'Amunts in this sectin may be different frm amunts reprted in Clumn B. 19. Outstanding Debts... Add Line 2 + Line 9 in Clumn B abve FPPC Frm 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gv (866/275-3772) www.fppc.ca.gv
Schedule E Payments Made Amunts may be runded t whle dllars. frm 7/1/17 SCHEDULE E thrugh 12/31 /17 Page _4_~ f 5_ I.D. NUMBER CODES: If ne f the fllwing cdes accurately describes the payment, yu may enter the cde. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member cmmunicatins RAD radi airtime and prductin csts CNS campaign cnsultants MTG meetings and appearances RFD returned cntributins CTa cntributin (explain nnmnetary)" OFC ffice expenses SAL campaign wrkers' salaries CVC civic dnatins PET petitin circulating TEL t.v. r cable airtime and prductin csts FIL candidate filing/ballt fees PHO phne banks TRC candidate travel, ldging, and meals FND fund raising events POL plling and survey research TRS staff/spuse travel, ldging, and meals IND independent expenditure supprting/ppsing thers (explain)" POS pstage, delivery and messenger services TSF transfer between cmmittees f the same candidate/spnsr LEG legal defense PRO prfessinal services (legal, accunting) VOT vter registratin LIT campaign literature and mailings PRT print ads WEB infrmatin technlgy csts (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITIEE. ALSO ENTER ) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Marin Histry Museum C/O Gary Rigghanti rnia cvc Histry museum 500 Albert Park Restratin San Rafael Cmmunity Center 618 S Street, San Rafael, Ca cvd Supprt Park 500 Secty State Frm 410 Sacrament fil 50 * Payments that are cntributins r independent expenditures must als be summarized n Schedule D. Schedule E Summary 1. Itemized payments made this perid. (Include all Schedule E subttals.) 2. Unitemized payments made this perid f under 100........ 3. Ttal interest paid this perid n lans. (Enter amunt frm Schedule S, Part 1, Clumn (e).)... 4. Ttal payments made this perid. (Add Lines 1, 2, and 3. Enter here and n the Summary Page, Clumn A, Line 6.) SUBTOTAL 1050 -----... ----- TOTAL FPPC Frm 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gv (866/275-3772) www.fppc.ca.gv
Schedule E (Cntinuatin Sheet) Payments Made Amunts may be runded t whle dllars. frm 7/1/17 SCHEDULE E (CONT) thrugh 12131/17 Page 5 f 5 CODES: If ne f the fllwing cdes accurately describes the payment, yu may enter the cde. Otherwise, describe the payment. CMP CNS CTS CVC FIL FND IND LEG LIT campaign paraphernalia/mise. campaign cnsultants cntributin (explain nnmnetary)* civic dnatins candidate filing/ballt fees fundraising events independent expenditure supprting/ppsing thers (explain)' legal defense campaign literature and mailings - NAME AND ADDRESS OF PAYEE (IF COMMITTEE. ALSO ENTER ) MBR MTG OFC PET PHO POL POS PRO PRT member cmmunicatins meetings and appearances ffice expenses petitin circulating phne banks plling and survey research pstage, delivery and messenger services prfessinal services (legal, accunting) print ads RAD radi airtime and prductin csts RFD returned cntributins SAL campaign wrkers' salaries TEL t.v. r cable airtime and prductin csts TRC candidate travel, ldging, and meals TRS staff/spuse travel, ldging, and meals TSF transfer between cmmittees f the same candidate/spnsr VOT vter registratin WEB infrmatin technlgy csts (internet, e-mail) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID San Rafael Plice Officers Assciatin Supprt POA San Rafael Public Library Fundatin Supprt Library Ritter Center 16 Ritter Street Nn-prfit; hmeless and in need evc 100 Cmmunity Media Center f Marin 81 9 A Street, Nn-prfit; cmmunity media Payments that are cntributins r independent expenditures must als be summarized n Schedule D. SUBTOTAL 400 FPPC Frm 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gv (866/275-3772)