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Home My Public Portal About410 Termination ( Dec. 17 2020)Statement of Organization Recipient Committee Statement Type ❑ Initial ❑ Amendment O Not yet qualified or 0 Date qualification threshold met Date qualification threshold met , m. I.D. Number mation 1424182 (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 C a(� Date Stamp . Mci ® Termination—See Pa rpe EIVE® ANDFIL ��j��S � , UNT` he Secretary of Stat of the State of California 2ia11 FEB ! 1 AM - 06 Date of termination DEC 2 81010 12 / 17/ 2020 CAMPAIGN FINANCE 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 AREACODE/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 I have used all reasonable diligence in preparing this statement and to the best of my knowledge the penalty of perjury under the laws of the State of California tha e foregoingistrue and correct. Executed on 12(2212020 BV / • 7-�- DATE Executed on 12/22/2020 By DATE Executed on DATE Executed on DATE By at'on contained herein is true and complete. I certify under SIGNATURE OF TREASURER OR ASSISTANT TREASURER CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By 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 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 3251 3829 3147 ADDRESS CITY STATE ZIP CODE 339 Yale Ave. Claremont CA 91711 1424182 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 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) CHECK ONE . SUPPORT Nonpartisan Partisan (list political party below) Nicole Wirick Claremont City Council Member, District 5 2020 21 0 Nonpartisan Partisan (list political party below) El 1:1 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) CHECK ONE FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov . SUPPORT OPPOSE SUP❑PO RT OM 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 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 Sponsored Committee List additional sponsors on an attachment. NAME OF SPONSOR STREET ADDRESS NO. AND STREET CITY INDUSTRY GROUP OR AFFILIATION OF SPONSOR Page 3 I.D. NUI 1424182 STATE ZIP CODE AREA CODE/PHONE 17ii7•IIIS•LI I/L1 f I (9iS•Li/u/l t 1=[� ❑ / Date qualified .. .� _..... «., .. v> . q ;�_ ._ „a, ...,. ,, a «.. ta..,,- •?a�:..'F2+x S.-TerlminatlonfRe uirements�` :'e<sl nm aheverificationethetreasurer-asslstant.treasure�=ando candidate;'oHiceholderor rg onenteernf,thatallghtg2it lowing,conditions'h,ave%een,met., -' + .. ..eF"m. ab �s�ez.;e�.zKw:. �r..., ..V.._g .g.,... ,�. ., .. ,�, ,...._ _.. ,......�.... /. .Y, P poen AY _ aancuu;rss��#s.��e • 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