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Home My Public Portal AboutForm 410 InitialStatement of Organization RECEIVED BY Recipient Committee LOS APlGf_ I Statement Type ® initial ❑ Amendment ❑ Termination — See Part 0 Not yet qualifiedJAN 29 PFS 12: 56 or 0 Date qualification threshold met Date qualification threshold mef A M PAI M Ibtf f l (V;V C P I.D. Number (if applicable) NAME OF COMMITTEE - Nicole Wirick for Claremont City Council 2020 STREET ADDRESS (NO P.O. BOX) 495 Notre Dame Rd. CITY STATE ZIP CODE AREA CODE/PHONE Claremont CA 91711 909-407-2843 FULL MAILING ADDRESS (IF DIFFERENT) P.O. Box 504, Claremont, CA 91711 E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) info@nicoleforclaremont.com COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Los Angeles Claremont, CA (jL �si2��o fv� Date Stamp ECEINED AND FIL the office of the Secretary of of the StA of California JAN '13 2020 For Official Use Only NAME OF TREASURER Jim Keith STREET ADDRESS (NO P.O. BOX) 337 Marygrove Rd CITY STATE ZIP CODE AREA CODE/PHONE Claremont CA 91711 909-451-1913 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE NAME OF PRINCIPAL OFFICER(S) Nicole Wirick STREET ADDRESS (NO P.O. BOX) 495 Notre Dame Rd. CITY; STATE ZIP CODE AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. Claremont CA 91711 909-407-2843 3 Vera cafion, � b � .� ,. :♦ �� 1 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 t regoing�nd correct. Executed on 01/09/2020' By DATE SIGOIATUUREOOF TREASURER OR ASSISTANT TREASURER Executed on 01/09/2020 By /' `' ' • .' VV co— C C IZ DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on I By 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 Statement of Organization CALIFORNIA, Recipient Committee • - INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER Nicole Wirick for Claremont City Council 2020 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER Bank of America 909-451-0974 ADDRESS CITY STATE ZIP CODE 339 Yale Ave. Claremont CA 91711 • 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 CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE Primarily Formed Committee'. 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 IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHFrK nNF SUPPORT Nonpartisan Partisan (list political party below) Nicole Wirick Claremont City Council Member, District 5 2020 L] Nonpartisan Partisan (list political party below) Primarily Formed Committee'. 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 IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHFrK nNF FPPC Form 410(August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SUPPORT OPPOSE 0 SUPPORT pp p E FPPC Form 410(August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D, NUMBER Nicole Wirick for Claremont City Council 2020 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 List additional sponsors on an attachment. NAME OF SPONSOR GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREACODE/PHONE Date qualified ea �a .,Y,.s, -_.. __.. a?. .:., e<.: .k .,.�.:•t�..�.r,.. �:�x�y:'3-;��r s[:s� .,_'�r.;,� 'a; �.,._w�--x t „�Tv:`_ 5 TerminatlonkRe ulrements `'By`slgning;the,verification, the treasurer assistantRreasurer•.and/oreandidate officeholder oriproponenYce fy-that all ofahe following,condittonslhave beenig • 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 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) — www.fppc.ca.gov