HomeMy Public PortalAboutForm 410 TerminationStatement of Organization
STREET ADDRESS (NO P.O. BOX)
Date Stamp'For
122 Brooks Ave
Recipient Committee{�Statement
CITY STATE ZIP CODE
AREA CODE/PHONE
zcourser@gmail.com
Claremont CA 91711
(909) 374-3958
Type
171Initial
El®
Termination —See Part 5Amendment `
Los Angeles
Oficial Use only
O Not yet qualified
STREET ADDRESS (NO PO. BOX)
JAN
CITY STATE 21P CODE
AREA CODE/PHONE
or
penalty of perjury under the laws of the State of Calif tha he foregoin is
ue and correct.
1 4 2019
Executed on G�1 By
JD TE'��^It 5 SIG NATUR ASURER OR ASSISTANT TREASURER
51
Executed on ` / By
Q Date qualification threshold met
Date qualification threshold met
Date of termination
Executed On $y
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
12 17/ 2018
CITY RK
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9
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1 Committee Information
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I.D. Number
(if applicable) 1393706
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��22�Treasui3er�zand,Other�PrfncfpalOfficers
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NAME OF COMMITTEE
Cach Courser for Claremont City Council 2018
STREET ADDRESS (NO P0.
122 Brooks Ave
CITY
Claremont
STATE ZIP CODE
CA 91711
NAME OF TREASURER
Steven A. Haskins
STREET ADDRESS (NO P.O. BOX)
1861 Bridgeport Ave
CITY
Claremont
AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
(909) 374-3958 Zachary Courser
STATE ZIPCODE
CA 91711
AREA CODE/PHONE
(909) 621-6830
FULL MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
122 Brooks Ave
E-MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL)
CITY STATE ZIP CODE
AREA CODE/PHONE
zcourser@gmail.com
Claremont CA 91711
(909) 374-3958
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE IS ACTIVE
NAME OF PRINCIPAL OFFICERS)
Los Angeles
City of Claremont
STREET ADDRESS (NO PO. BOX)
Attach additional information on appropriately labeled continuation sheets.
CITY STATE 21P CODE
AREA CODE/PHONE
3 :;Uerf cattonx_5 x f,;f t..
v€.'�x.
I have used all reasonable diligence in preparing this statement and to the best my knowledge the information contained herein is true and complete. I certify under
penalty of perjury under the laws of the State of Calif tha he foregoin is
ue and correct.
Executed on G�1 By
JD TE'��^It 5 SIG NATUR ASURER OR ASSISTANT TREASURER
51
Executed on ` / By
WE SIGNATURE OF C NT OLLING OFFIC (I!OLD[P., CANDIDATE, OR STATE MEASURE PROPO
Executed On $y
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