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Home My Public Portal AboutForm 410 AmendmentStatement of Organization Recipient Committee Statement Type ❑ Initial 0 Amendment 0 Not yet qualified Or 0 Date qualification threshold met Date qualification threshold met 06 / 28 2020 I.D. Number �1: Committee informafiorr (if (applicable) 1425517 NAME OF COMMITTEE Corey Calaycay for Claremont City Council 2020 C ) r; -'l -C VI'l RECEIVED AND I in the office of the Secretary If the State of calif,,.., ❑ Term inakt&-4:6 M5 STREET ADDRESS (NO P.O. BOX) 1555 W. Base Line Road CITY STATE ZIP CODE AREA CODE/PHONE Claremont CA 91711 (909) 593-5913 FULL MAILING ADDRESS (IF DIFFERENT) 2058 N Mills Ave #722, Claremont, CA 91711 E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) spearson67@gmail.com COUNTY OF DOMICILE- JURISDICTION WHERE COMMITTEE 15 ACTIVE Los Angeles Claremont, CA Attach additional information on appropriately labeled continuation sheets Date of termination — .1 V CALIFORNIA Ov E 11'� FORM 4171 (S !-^.P'�l.aEL�JaIiiUUli� a y— J U L 2 1 2020 CITY CLERK t X20AUG 10 PPI �: 56 ITY OF CLAREMO1V r�,F�i�' GN F I��ANCF NAME OF TREASURER Susan Pearson STREET ADDRESS (NO P.O. BOX) 2461 San Jacinto Ct CITY STATE ZIP CODE AREA CODE/PHONE Claremont CA 91711 (909) 921-4357 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE NAME OF PRINCIPAL OFFICER(S) Corey Calaycay STREET ADDRESS (NO P.O. BOX) 1555 W. Base Line Road CITY STATE ZIP CODE AREA CODE/PHONE Claremont CA 91711 (909) 593-5913 117%U rt icafion l . I have used all reasonable diligence in preparing' stateme t 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 orni t t the foregoing is true and correct. Executed on 7/6/2020 By DATEATURE OF TREASURER OR ASSISTANT TREASURER Executed on Executed on 7/6/2020 DATE DATE Executed on DATE By By By NATURE OF R, CA(VDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT 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 dL- I Statement of Organization CALIFORNIA' Recipient Committee • - INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER Corey Calaycay for Claremont City Council 2020 1425517 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER OneWest Bank 877-741-9378 1203035044 ADDRESS CITY STATE ZIP CODE 21.11 Bonita Ave La Verne CA 91750 • 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) rHFCK ONP SUPPORT r-1 Nonpartisan Partisan (list political party below) Corey Calaycay City Council Member 2020 Nonpartisan Partisan (list political party below) El 1:1 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) rHFCK ONP FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SUPPORT r-1 OPPOSE EL SUPPORT OPP 5 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 3 COMMITTEE NAME I.D. NUMBER Corey Calaycay for Claremont City Council 2020 1425517 General Purpose Committee 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 Sponsored Commiffee List additional sponsors on an attachment. NAME OF SPONSOR STREET ADDRESS NO. AND STREET CITY INDUSTRY GROUP OR AFFILIATION OF SPONSOR STAFE ZIP CODE AREA CODE/PHONE l�7t rt JIIR�LI SII �1 ❑ {gLS�L� I u II � 4'l� Date qualified [. ...:. .. __ . ,.t. ..: .. }.,..X. - =•..: A:: �"-#. x i4;:- :..a ....�..+-.u..e _ .. *x:$Os;.7K'"'.."=.....,c.:.iK�`rc'?s,rHct�t:+'-`+II..}...t..'rno..,..Yah....pYA."X.r.,...,.b3A7.},.a.,Tw- 01rz.;d+.wTi 'tY�lta%7Or1ReC�Nlemnts` Q Byslgngthe�yPnficauthe'treasu er asslsta�nt treater and/oreand date,officgholder orpppore� n��t cerhfyt ado the following;conditTons`h ve=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 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov