HomeMy Public PortalAboutForm 410 TerminationStatement of OrganizationWES Date Stamp c-ALIFORNIA ,n
Recipient Committee E --j-a�w
Statement Type ❑ initial ❑ Amendment ® Termination — see Part 5 For Official Use Only
Q Not yet qualified A N 2 1 2020
or 12 31 2019
• Date qualified as committee —✓—� —�—� CITY C�
Date qualified as committee Date of termination ���
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1. Committee Information I.D. Number -T -2Treasurer and Other. Principal Officers
(if applicable)
NAME OF COMMITTEE NAME OF TREASURER
Jennifer Stark for Claremont City Council 2018 Joe Hough
STREET ADDRESS (NO P.O. BOX)
580 W. 8th Street
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE
242 Eagle Grove Avenue
CITY STATE ZIP CODE AREACODE/PHONE
Claremont CA 91711 909-913-2580
MAILING ADDRESS (IF DIFFERENT)
2058 N Mills Ave, #425, Claremont, CA 91711
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
jenniferstark20l8@gmail.com
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Los Angeles County Claremont (Los Angeles County)
Attach additional information on appropriately labeled continuation sheets.
Claremont
CA
91711
909-625-3236
NAME OF ASSISTANT TREASURER, IF ANY
Simon Brown
STREET ADDRESS (NO P.O. BOX)
1420 N Claremont Blvd, Ste 204C
CITY
STATE
ZIP CODE
AREACODE/PHONE
Claremont
CA
91711
909-541-0713
NAME OF PRINCIPAL OFFICER(S)
Diann Ring
STREET ADDRESS (NO P.O. BOX)
816 Peninsula Avenue
CITY
STATE
ZIP CODE
AREACODE/PHONE
Claremont
CA
91711
909-2384402
3.. Verification
I have used all reasonable diligence in preparing thi ment and t est of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury under the laws of the State of lif rnia the the fegoi is true and correct.
Executedon 'A mr-0 By +
DATE C SIGNATURET7ERORASSISTJrT EASURER
Executed on y /
DAT / SIGNATURE OF NTROL G OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By I
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (October/2017)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Jennifer Stark for Claremont City Council 2018
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
Bank of America
ADDRESS
AREA CODE/PHONE
909-447-3485
CITY
ACCOUNT NUMBER
325087297498
STATE ZIPCODE
E2
NUMBER
339 Yale Avenue Claremont CA 91711
4. Type of Committee Complete the applicable sections.
ControlledCommittee
• 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 "nonpartisan." Stating "No party preference" is acceptable.
• 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 YEAR OF PARTY
NAME OF CAN MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
Jennifer Stark
Claremont City Council
2018
Nonpartisan
✓
Partisan (list political party below)
Nonpartisan
Partisan (list political party below)
Primorif
• 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)
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT I OPPOSE
OPPOSE
FPPC Form 410 (October/2017)
Clear Page Print FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Jennifer Stark for Claremont City Council 2018
Page 3
I.D. NUI
4. Type of.Committee (Continued)
General • • Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee ❑ Political Party/Central Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
• [ - • List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFRUATION OF SPONSOR
J
STREET ADDRESS NO. AND STREET CITY STATE ZIPCODE AREACODE/PHONE
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Date qualified
S. 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 gov (October/2717)
Clear Page Print FPPC Advice: advice@fppc.w.gov (866/275-3772)
www.fppc.ca.gov