HomeMy Public PortalAboutForm 410 TerminationCIM
Statement o OrganizationCALIFORNIA
Date Stamp
Recipient Committee
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FORM
Statement Type ElInitial ElAmendment
® Termination —See Part5
e °ffce of the Secretary of Stat
For Official Use Only
of the State of California
2021 FEB I I AM 10: 06
Q Not yet qualified
orDEC
Q Date qualification threshold met Date qualification threshold met
Date of termination
311020
C A WA I G N FINANCE
2020
I.D. Number 1429606
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NAME OF COMMITTEE
NAME OF TREASURER
ZACH COURSER FOR CLAREMONT CITY COUNCIL 2020
LINDA MOORE
STREET ADDRESS (NO P.O. BOX)
413 WILLAMETTE
LN
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE AREA CODE/PHONE
1142 N CAMBRIDGE AVE
CLAREMONT
CA
91711 909-210-3704
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
CLAREMONT CA 91711 617-901-8787
FULL MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL)
CITY
STATE
ZIP CODE AREA CODE/PHONE
zcourser@gmail.com
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE IS ACTIVE
NAME OF PRINCIPAL OFFICER(S)
LOS ANGELES
CITY OF CLAREMONT
STREET ADDRESS (NO P.O. BOX)
Attach additional information on appropriately labeled continuation sheets.
CITY
STATE
ZIP CODE AREA CODE/PHONE
I have used all reasonable diligence in preparing
penalty of perjury under the laws of the Sta e of
Executed on Z ! 2 2!/ , 2,v By r'
DATE
L/ZC�c�
Executed on By
DATE
Executed on By
DATE
Executed on By
DATE
atement and to the best of my knowledge the information contained herein
dia thathe foregoin is tru nd correct.
--
�' SIGNATUR&OF TREASURER OR ASSISTANT TREASURER
SIGNATURE O NTRO LLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
/\{
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
complete. I certity un
FPPC Form 410(August/2018)
FPPC Advice: Lw.fp
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D. NUMBER
ZACH COURSER FOR CLAREMONT CITY COUNCIL 2020 1429606
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
WELLS FARGO (909) 398-1140 5302825889
ADDRESS CITY STATE ZIP CODE
203 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
CH ECK ONE
Primarily Formed Committee M Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MFASURE(S) JURISDICTION
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410(August/2018)
FPPC Advice: advice_@fppc _ca.>:ov (866/275-3772)
wwW.fppc.ca.KOV
Nonpartisan
Partisan
(list political party below)
ZACH COURSER
CLAREMONT CITY COUNCIL POSITION 1
2020
1(
Nonpartisan
Partisan
(list political party below)
Primarily Formed Committee M Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MFASURE(S) JURISDICTION
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410(August/2018)
FPPC Advice: advice_@fppc _ca.>:ov (866/275-3772)
wwW.fppc.ca.KOV