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HomeMy Public PortalAboutForm 410 TerminationStatement of Organization Ir a� . }�S TEMENT OF ORGANIZATION Recipient Committee Type or print in ink ,� HJate staffive, � � 1 Statement Type ❑ Initial Amendment Termination See Part 5 JIN 5 1� For Official Use Only Not et qualified ❑ or y q List I.D. number: List I.D. numti+?r: i I 2 0 �.. P F �" F # # 1328535 _ S + t,Rore � �� z 4 1 1 1j. 110 Date qualified as committee Date qualified as committee Date of Termination (If applicable) 1. Committee Information 2. NAME OF COMMITTEE Haulman For Claremont City Council 2011 STREET ADDRESS (NO P.O. BOX) 409-B Central Ave CITY STATE ZIP CODE AREACODE/PHONE Upland CA 91786 9099825987 MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX/ E-MAIL ADDRESS OF DOMICILEI COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE Los Angeles Attach additional information on appropriately labeled continuation sheets. Treasurer and Other Principal Officers NAME OF TREASURER William M. Baker STREET ADDRESS (NO P.O. BOX) 409-B Central Ave. CITY STATE ZIP CODE AREA CODE/PHONE Upland CA 91786 9099825987 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is a and complete. I certify under penalty of perjury under the laws fith � ± Of California that the foregoing is true and correct. Executed on 6 j� ' , By Executed on W1 IIIA A g1 I By Executed on L IL ^ _ By Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (June/09) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) 4 Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE STATEMENT OF ORGANIZATION COMMITTEE NAME I.D. NUMBER Haulman For Claremont City Council 2011 1 1328535 4. 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 with which each officeholder or candidate is affiliated or check "non-partisan." 0 • 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 NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Robin Haulman City Council 2011 © Non -Partisan ❑ Non -Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION California Bank & Trust ADDRESS AREA CODE/PHONE 9096249091 NT NUMBCFH 3780107481 STATE ZIP CODE 102 N. Yale Ave. Claremont CA 91711 Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE SUPPORT IOPPOSE FPPC Form 410 (April/2011) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)