HomeMy Public PortalAboutForm 410 TerminationStatement of Organization
Recipient Committee
Statement Type
l�
❑ Initial
Not yet qualified ❑ or
Date qualified as committee
1. Committee Information
NAME OF COMMITTEE
Joe Lyons for City Council
Type or print in ink u E Date Stamp
IF
a�
t
❑ Amendment ® ,Termination —See Part 5• RECEIVED ,>��+
!n theoffice of file Secretary o�
List I.D. number.
Litt 1.D.'` number: ' f the State v;
1334259 California
# #JUL 2 Q
6 F 30 11 2 Q j,
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Date qualified as committee Date of Termination DEBRA�9At�A�
(If applicable) - �'!r fid
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2. Treasurer and Other Principal"OfiffEers
NAME OF TREASURER
J. Michael Fay
STREETADDRESS (NO P.O. BOX)
4085 Olive Hill Dr.
STREETADDRESS (NO P.O. BOX)
1774 Chatham Ct.
CITY
Claremont,
STATE ZIP CODE
CA 91711
MAILING ADDRESS (IF DIFFERENT)
4085 Olive Hill Dr, Claremont, CA 91711-1414
OPTIONAL: FAX/E-MAILADDRESS
fayhome@claremontfinancial.com
AREA CODE/PHONE
909-392-0020
COUNTY OF DOMICILEI COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Los Angeles
Attach additional information on appropriately labeled continuation sheets.
STATEMENT OF ORGANIZATION
For Official Use Only
CITY STATE ZIP CODE AREA CODE/PHONE
Claremont CA 91711-1414 909-624-6939
NAME OF ASSISTANT TREASURER, IF ANY
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREACODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREACODE/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 true and complete. I certify under penalty of
perjury under the laws of the State of California that the foregoing is true and correct.
July 14, 2011
Executed on By
DATE - AlRE FTR ASURE 0 SS ANT TREASURER
Executed on 7 — I �' ^ ro i i By
DATE CIr MATT IRG n TR(1 IMf; (1FGI(`FHfll f1FR II ATF r1RCTATF MFACI IRF. P.M'P MFMT
Executed on
DATE
Executed on
DATE
By
. . 'SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
FPPC Form 410 (April/2011)
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)
C
4
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Joe Lyons for City Council
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
STATEMENT OF ORGANIZATION
Page 3
1334259
.. / • . List additional sponsors on an attachment. 0
NAME OF SPONSOR
STREETADDRESS
AND STREET
CITY
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE
�7LE=II �o'Irlltl!)ll/t{•]��SU/Ill?/1 t {=ice
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 (April/2011)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)