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Home My Public Portal AboutForm 410 Termination Statement of Organization Recipient Committee STATEMENT OF ORGANIZATION Type or print in ink Statement Type Olnitia. Not yet qualified 0 or o Amendment List 1.0. number: X Tennination - See Part 5 List 1.0. number: #J"lH31...1 ~ -L~~ Date of Termination , I'VED I: ,.~_ _ _II . ...0 CALIFORNIA 410 FORM For Offidal Use Only # AUG f' ~ 1 3 2007 ---1---1_ Date qualified as committee ---1---1_ Date qualified as committee (tfapplieable) CllY CLERK e\'Of ClAAEMllHT Ci' . 1. Committee Information 2. Treasurer and Other Principal Officers NAME OF COMMITTEE Cl nuN? ~( MA~/,.~D STREET ADDRESS (NO P.O. BOX) SOl ~ EOJLN!lI (>QJ~ CITY c.-[ W G Mo Lit' STREET ADDRESS ~ 707 CITY NAME OF TREASURER M\ thAf ( L MA ~l.{D ~r;.A)O/A GIAm'MO(\/f .Avf STATE ZIP CODE CA- '1'7/1 AREA CODE/PHONE 909 2b7-t08'f STATE CA: ZIP CODE 't17/( AREA CODElPHONE ttrf1 Ul- %O~~ NAME OF ASSISTANT TREASURER, IF Am MAILING ADDRESS (IF D1FFERENl) STREET ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX' E-MAIL ADDRESS NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE COUNTY OF DOMICILE 0J') ~l\7deS COUNTY WI-IERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge th perjury under the laws of he 5 te of California that the foregoing is true and correct. Executed on By Executed on By OAT Executed on By OATE Executed on By DATE mplete. I certify under penalty of TREASURER SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROlLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (January/OS) FPPC Tol~Fr.. Helpline: 866/ASK-FPPC (866/27S-3772) Statement of Organization Recipient Committee STATEMENT OF ORGANIZATION COMMITTEE NAME (, CALIFORNIA 41 0 FORM INSTRUCTIONS ON REVERSE f Mh(;.!-{O I.D. r;? 40 Type of Committee Complete the applicable sections. Controlled Committee . 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 w~h which each officeholder or candidate is affiliated or check Onon-partisan." . If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION l c -hA~1 L. MAGLev cl,"r';M.ONT G'fy Lt>vfJid!4QJ1 2007 PARTY o Non-Partisan T<E o Non-Partisan . List the financial institution where the campaign bank account is located (controlled Mcandidate election~ committees only) NAME OF FINANCIAL INSTITUTION Wt\15 ti\g.'v fAit O~ C IN/: ~~+- AREA CODE/PHONE ?/!r-II'/O C~ BANK ACCOUNT NUMBER "20> ~K AuF lTI- 4/(,4'-)r STATE ZIP CODE '11 7/1 ADDRESS Pnmanly Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. list below: CANDlDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BAUOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO" CITY OR COUNTY, AS APPUCABLE) CHECK ONE 1-"1-" SUPPORT OPPOSE FPPC Fonn 410 (January/OS) FPPC Tol~Free Helpline: 866/ASK-FPPC (866/275-3772) Statement of Organization Recipient Committee STATEMENT OF ORGANIZATION 9 COMMITTEE NAME 1.0. NUMBER INSTRUCTIONS ON REVERSE CALIFORNIA 41 0 FORM 4. Type of Committee (Continued) General Purpose Comnllttee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: D CITY Committee D COUNTY Committee D STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVllY Sponsored Comn1lttee List additional sponsors on an attachment. INDUSTRY GROUP OR AFFILIATION OF SPONSOR NAME OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE Small Contributor Committee o ---.-J--1_ Check box and provide the date thls committee qualified as a small contributor committee. If the committee qualified as a Date qualified small contributor committee on January 1,2001, enter 1/1/01. 5. Term ination Requ irements By signing the verification. the treasurer, assistant treasurer and/or candidate. officehokier, 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. FPPC Form 410 (January/05) FPPC Tol~Free Helpline: 866/ASK-FPPC (866/275-3772) Statement of Organization Recipient Committee STATEMENT OF ORGANIZATION Type or print In ink ErVED CALIFORNIA 41 0 FORM For Official Use Only Statement Type o Initial Not yet qualified 0 or o Amendment List 1.0. number: iii Tenninalion - See Part 5 List 1.0. number: LlAY 1 7 2001 ----1----1_ Date qualified as committee ----1----1_ Date qualified as committee (lfapplicllble) # 1249955 ~~~ Date of Termination CITY CLERK CITY OF ClAREMONT # STREET ADDRESS (NO PO, BOX) 2. Treasurer and Other Principal Officers NAME OF TREASURER William Stoner STREET ADDRESS 2341 Oxford St CITY STATE ZIP CODe AREA CODE/PHONE 1. Committee Information NAME OF COMMITTEE Committee to elect Jackie McHenry 2467 Wood Court CITY STATE ZIP CODe AREA CODE/PHONE Claremont CA 91711 NAME OF ASSISTANT TREASURER, IF ANY David Wishart STREET ADDRESS 524 Contra Costa Way CITY Claremont CA 91711 NAME AND POStTlON OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE STATE ZIP CODE AREA CODE/PHONE Claremont CA 91711 MAILING ADDRESS (IF DIFFERENT) OPTlONAL: FAX f E.MAIL ADDRESS COUNTY Of DOMICilE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE MAILING ADDRESS Los Angeles CITY STATE ZIP CODE AREA CODElPHONE Attach additional infonnation on appropriately labeled continuation sheets. 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge the infonnation contained herein is true and complete. perjury under the laws of the State of California that the foregoing is true and correct. ,t, ~ Executed on '//z..7 /07 By .IJJ:,.-uJ /!~ DATE ' (j SIGNATURE Of TREASURER OR ASSISTANT TREASURER Executed on Y / d- '7/07 BY- . "'1 DATE I certify under penatty of Executed on HOlDER CANDIDATE, OR STATE MEASURE PROPONENT DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE. OR STATE MEASURE PROPONENT Executed on By SIGNATURE OF CONTROlLING OFFICEHOlDER CANDIDATE, OR STATE MEASURE PROPONENT DATE FPPC Form 410 (JanuaryI05) FPPC Tol~Free Helpline: 866IASK-FPPC (8861275-3m) Statement of Organization Recipient Committee STATEMENT OF ORGANIZATION INSTRUCTIONS ON REVERSE CALIFORNIA 41 0 FORM COMMllTEE NAME 1.0. NUMBER 4. Type of Committee (Continued) General Pllrposp Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: o CITY Commillee 0 COUNTY Commillee 0 STATE Commillee PROVIDE BRIEF DESCRIPTION OF ACTIVITY Sponsored CommIttee List additional sponsors on an attachment. NAME Of SPONSOR INDUSTRY GROUP OR AFFtLlATlON OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE Small Contributor Commfttee o ----1-'_ Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a Date qualified small contributor committee on January 1, 2001, enter 1/1/01. 5. Tennination Requirements By signing the verification, the treasurer, assistant treasurer andlorcandidate, 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 Mure; This committee has eliminated or has no intention or ability to discharge ali 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 disdosing ali 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. FPPC Form 410 (JanuaryI05) FPPC Toll-Free Helpline: 866/ASK-FPPC (8881275-3n2) Instructions for Statement of Organization CALIFORNIA 41 0 FORM Sponsored Committee A "sponsored committee" is a general purpose or primarily formed committee, other than an officeholder or candidate controlled committee, that has one or more sponsors. An organization, business, or other entity is a sponsor if one or more of the following apply: . The committee receives 80% or more of its contributions from the entity or organization or its members, officers, employees, or shareholders. . The entity or organization collects contributions for the committee by use of payroll deductions or dues from its members, officers or employees. . The entity or organization, alone or in combination with other entities or organizations, provides all or nearty all of the administrative services for the committee. . The entity or organization, alone or in combination with other entities or organizations, sets the policies for contribution soiicitations or payment of expenditures from committee funds. See the instructions for Part 1 for name identification requirements. Small Contributor Committee A "small contributor committee" is one that: . Has been in existence for more than six months; . Receives contributions from 100 or more persons; . Makes contributions to five or more candidates; and . Has not received more than $200 from one person in a calendar year. See FPPC Regulation 18503. 5. Termination Requirements Recipient committees do not automatically terminate; they may only terminate under the following circumstances: . They have ceased to receive contributions and make expenditures; and . They do not anticipate receiving contributions, repayments of outstanding loans mad~ to others, or any other receipts in the future, and they do not anticipate making expenditures in the future; and . They have eliminated or have no intention or ability to discharge all their debts, loans received, and other obligations; and . They have no campaign funds; and . They have filed all required campaign statements disclosing all reportable transactions, including disposition of funds. Stale Candidates: There are specific mandatory termination deadlines applicable to your controlled committees. See FPPC Campaign Discl"sure Manual 1 for state candidates. How to Terminate State Recipient Committees . File an original and one copy of the Form 410 Statement of Organization Termination along with an original and one copy of your Form 450 or 460 with the Secretary of State. . File two copies of your Form 450 or 460 with your local filing officials. Local Recipient Committees . File an original and one copy of the Form 410 Statement of Organization Termination with the Secretary of State; and . File a copy of the Form 410 Statement of Organization Termination, along with an original and one copy of your Form 450 or 460 with your filing officer. FPPC Form 410 (JanuaryJ05) FPPC Toll-Free Helpline: 8661ASK-FPPC (866/215-3772)