The URL can be used to link to this page

Home My Public Portal AboutForm 460 (July 1 - Sept. 19, 2020)COVER PAGE Recipient Committee Date Stamp Campaign Statement U9' • Cover Page Statement covers period from 7/1/20 SEE INSTRUCTIONS ON REVERSE 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part 5) 0 Sponsored (Also Complete Part 6) ❑ General Purpose Committee 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1424182 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO 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 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX P.O. Box 504 CITY STATE ZIP CODE AREA CODE/PHONE Claremont CA 91711 OPTIONAL: FAX/ E-MAIL ADDRESS Date of election if applicable: (Month, Day, Year) SEP 2 3 2020 I CIT`( CLERK 11/3/20 TY OF CLAREMON 2. Type of Statement: Page 1 of 8 For Official Use Only ❑ Preelection Statement ❑ Quarterly Statement ❑ Semi-annual Statement ❑ Special Odd -Year Report Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Jim Keith MAILING ADDRESS P.O. Box 504 CITY STATE, ZIP CODE AREA CODE/PHONE Claremont CA 91711 909-451-1913 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS info@nicoleforclaremont.com jim.keith9@verizon.net 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the info rmation.contained herein and in the attached schedules is true and complete certify under penalty of perjury under the laws of the State of California that the foregoing is true andel ct. Executed on 9/19/20 Date Executed on 9/19/20 Date Executed on Date Executed on Date By r vs -ti Signature of Treasurer or Assistant Treasurer By Signature of Controlling Officeholder, Candidate, Slate Measure Proponent or Responsible Officer of Sponsor By Signature of Controlling Officeholder, Candidate, State Measure Proponent By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov 'Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Nicole Wirick OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Claremont City Council Member, District 5 RESIDENTIAL/BUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP 495 Notre Dame Rd Claremont CA 91711 Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. I.D. NUMBER NAME OF TREASURER [CONTROLLED COMMITTEE? YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 Page 2 of 8 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee Listnames of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov „Campaign Disclosure Statement Amounts may be rounded SUMMARY PAGE Summary Pae to whole dollars. Statement covers period from , g 7/1/20 .. • 1 through 9/19/20 Page -1- of 8 SEE INSTRUCTIONS ON REVERSE g NAME OF FILER I.D. NUMBER Nicole Wirick for Claremont City Council 2020 1424182 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDAR YEAR (FROM ATTACHED SCHEDULES) TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions................................................... Schedule A, Line $ 250 $ 1,700 2. Loans Received................................................................ schedule e, Line 3 -664 0 yr through sl3o 7i1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $ -414 4. Nonmonetary Contributions ............................................ schedule C, Line 3 59 5. TOTAL CONTRIBUTIONS RECEIVED................................Add Lines 3+4 $ -355 $ 1,700 327 $ 2,027 Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 665 $ 1,700 7. Loans Made....................................................................... Schedule H, Line 3 none none 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 665 $ 1,700 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 none none 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 59 327 11. TOTAL EXPENDITURES MADE....................................Add Lines 8+9+1p $ 115 $ 2,027 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 1,079 To calculate Column B, 13. Cash Receipts........................................................... Column A, Line 3 above -414 add amounts in Column A to the corresponding 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 none amounts from Column B 15. Cash Payments......................................................... Column A, Line 8 above 665 of your last report. Some amounts in Column A may 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 0 be negative figures that should be subtracted from If this is a termination statement, Line 16 must be zero. previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED Schedule e, Part 2 $ none filed for this calendar year, ................................ only carry over the amounts from Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts any). 18. Cash Equivalents ................................................ See instructions on reverse $ none 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column 8 above $ none 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made” (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A 'Monetary Contributions Received to wnoie ooilars. Statement covers period ' from 7/1/20FORMI • through 9/19/20 Page 4 of 8 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Nicole Wirick for Claremont City Council 2020 FULL NAME, STREET ADDRESS AND ZIP CODE OF IFAN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBUTOR * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) El IND 1/27/20 Jim Keith ❑COM Site Supervisor None $100 337 Marygrove Rd ❑ OTH Claremont After -School Claremont, CA 91711 ❑ PTY Program ❑ SCC Z IND 2/27/20 Russell Belevick ❑ COM Retired None $100 361 Marygrove Rd ❑ OTH Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 3/2/20 Karen Wirick ❑ COM Fundraiser None $250 3909 Mayfield Ave ❑ OTH Children's Hospital of La Crescenta, CA 91214 ❑ PTY Los Angeles ❑ SCC Z IND 3/2/20 Wallace Wirick El COM Retired None $250 3909 Mayfield Ave ❑ OTH La Crescenta, CA 91214 ❑ PTY ❑ SCC IND 3/5/20 Dan Selmi ❑ COM Retired None $250 106 Grand Canal ❑ OTH Balboa Island, CA 92662 ❑ PTY ❑ SCC SUBTOTAL $ p �Y L Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.) .............................................. 2. Amount received this period — unitemized monetary contributions of less than $100 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.). 'Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE A (CONT.) Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA from 7/ 1/20 • . • Page 5 of 8 through 9/19/20 NAME OF FILER I.D. NUMBER Nicole Wirick for Claremont City Council 2020 1424182 FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBUTOR * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME) PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) ®IND 3/5/20 Ann Selmi El COM Professor None $250 106 Grand Canal ❑ OTH Cal State University Balboa Island, CA 92662 ❑ PTY Dominguez Hills ❑ SCC Z IND 3/9/20 Bob Gerecke El COM Retired None $100 333 Villanova Rd ❑ OTH Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 5/11/20 Kirith Dilley El COM Nonprofit Leader None $100 247 N Bush St ❑ OTH Alta Med Health Services Santa Ana, CA 92701 ❑ PTY ❑ SCC Z IND 7/8/20 Mac McLoughlin El COM Consultant $250 $250 2074 Gatun St. ❑ OTH No separate business name Del Mar, CA 92014 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY El SCC SUBTOTAL $ 250y *Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE B - PART 1 Schedule B — Part 1 Statement covers period _ ' Loans Received from 7/1/20 • 6 of 8 through 9/19/20page SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Nicole Wirick for Claremont City Council 2020 1424182 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OF LENDER BALANCE RECEIVED THIS OR FORGIVEN BALANCE AT PAID THIS AMOUNT OF _CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER BEGINNING THIS PERIOD THIS PERIOD* CLOPERIOD ECIFTHIS PERIOD LOAN TO DATE NAME OF BUSINESS) PERIOD ® PAID CALENDAR YEAR Nicole Wirick Deputy Public Defender $ 664 $ None % $ 664 $ 664 495 Notre Dame Rd County of San Bernardino FORGIVEN E] FORGIVEN PER ELECTION" Claremont, CA 91711 664 None $ $ $ 0 11/3/20 $ 0 1/6/20 $ 664 t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION" RATE 1 ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED _ ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION'" RATE DATE DUE DATE INCURRED t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ None $ 664 $ None $ 0},„��r4s1 Schedule B Summary 1. Loans received this period.......................................................................... (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period............................................................... (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) ............................. Enter the net here and on the Summary Page, Column A, Line 2. 'Amounts forgiven or paid by another party also must be reported on Schedule A. If required. $ None 664 NET $ -664 (May be a negative number) (Enter (e) on Schedule E, Line 3) tContributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule C Amounts may be rounded SCHFnIII F C "' W1„'1C UV1101a. Nonmonetary Contributions Received Statement covers period from 7/1/20SEE of 8 F through 9/19/20 INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Nicole Wirick for Claremont City Council 2020 1424182 DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ CUMULATIVE TO DATE PER ELECTION TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) * CODE (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) GOODS OR SERVICES FAIR MARKET VALUE CALENDAR YEAR (,JAN 1 - DEC 31) (IF REQUIRED) ® IND 1/7/20- Jim Keith ❑ COM Site Supervisor Election Filing Fee None $142 1/10/20 337 Marygrove Rd ❑ OTH Claremont After -School and Post Office Claremont, CA 91711 ❑ PTY Program Box ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ None Schedule C Summary Amount received this period — itemized nonmonetary contributions. (Include all Schedule C subtotals.).................................................... 2. Amount received this period — unitemized nonmonetary contributions of less than $100 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.). None ...............$ ...................... $ TOTAL $ 59 59 *Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Nicole Wirick for Claremont City Council 2020 Amounts may be rounded to whole dollars. Statement covers period from 7/1/20 through 9/19/20 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. SCHEDULEE :ALIFURNIA 460 FORM i I.D. NUMBER 1424182 CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)" OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)" POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR . DESCRIPTION OF PAYMENT * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.)................................................................................... 2. Unitemized payments made this period of under $100................................................................................................................ 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).)................................................... 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) .............. AMOUNT PAID SUBTOTAL $ None None ........................ $ 665 ........................ $ $ None ........... TOTAL $ 665 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov