HomeMy Public PortalAboutForm 410 TerminationStatement of Organization
Recipient Committee
STREET ADDRESS (NO P.O. BOX)
2058 N Mills Ave Suite 430
CITY
Claremont
FULL MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
COUNTY OF DOMICILE
STATE ZIP CODE
CA 91711
JURISDICTION WHERE COMMITTEE IS ACTIVE
AREA CODE/PHONE
909 575-1456
Attach additional information on appropriately labeled continuation sheets.
C�atL �L�L.
Termination —See Part 5
JAN 9 2 2099 For Official Use Only
COTY CLERK
Date of termination � ITY OF CLAREMON F
12 � 31� 2018
NAME OF TREASURER
William Buehler
STREET ADDRESS (NO P.O. BOX)
304 E Miramar Ave
CITY
Claremont
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE
CA 91711
STATE ZIP CODE
STATE ZIP CODE
I have .-, _ _
used all_reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and com
penalty of perjury under the laws of the State of California that t e foregoing is true and correct.
Executed on January 21, 2019 By
DATE SIGNATUR176F TREAS ER OR ASSISTANT TREASURER
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
Executed on By
DATE 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
AREA CODE/PHONE
909 262-9922
AREA CODE/PHONE
AREA CODE/PHONE
I certify under