HomeMy Public PortalAboutForm 410 AmendmentStatement of Organization
Recipient Committee
Statement Type V (nitial
Not yet qualified or
I_ 1
Date qualified as committee
1. Committee Information
NAME OF COMMITTEE
Haulman for Claremont City Council 2011
Type or print in ink
mendment
List I.D. number:
Date qualified as committee
(If applicable)
STREETADDRESS (NO P.O. BOX)
409-B Central Avenue Upland, CA 91786 909-624-0533
CITY
MAILING ADDRESS (IF DIFFERENT)
❑ Termination -- See Part 5
List I.D. number:
#
STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX/ E-MAIL ADDRESS
909-624-0543
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Los Angeles
Attach additional information on appropriately labeled continuation sheets.
Date of Termination
2. Treasurer and Other Principal
STATEMENT OF ORGANIZATION
For Official Use Only
NAME OF TREASURER
William Baker
STREET ADDRESS (NO P.O. BOX)
409-B Central Avenue Upland
CA 91786
909-9825987
CITY
STATE ZIP CODE
AREACODE/PHONE
N/A
NAME OF ASSISTANT TREASURER. IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE
AREA CODE/PHONE
H. Rita Topalian
NAME OF PRINCIPAL OFFICER(S)
7211 Painter Avenue
STREET ADDRESS (NO P.O. BOX)
Whittier CA
90602
562-907-7889
CITY
STATE ZIP CODE
AREA CODEIPHONE
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained hereil is true and complete. I certify under penalty of
perjury under the laws of the State of California that the foregoing is true ar
Executed on July '7 , 2010 By
DATE
Executed on July, 2010 By
DATE
Executed on
DATE
Executed on
DATE
By
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 490 (June/09)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)
0
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
HAULMAN FOR CLAREMONT CITY COUNCIL 2011
4. Type of Committee Complete the applicable sections.
STATEMENT OF ORGANIZATION
• 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."
• 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
CLAREMONT 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 and Trust
ADDRESS
102 N. Yale Avenue Claremont
AREA CODE/PHONE BANK ACCOUNT NUMBER
909-624-9091
CITY STATE ZIP CODE
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
N/A
OPPOSE
FPPC Form 410 (June/09)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)
C
O
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
HAULMAN FOR CLAREMONT CITY COUNCIL 2011
4. Type of Committee (Continued)
.. Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
[]CITY Committee []COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY 0
NIA
.'. . . List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREETADDRESS NO. AND STREET CITY STATE ZIP CODE
N/A
Date qualified
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, 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 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.
-- Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511 -
89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410 (June/09)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)