HomeMy Public PortalAboutCPOA PAC Form 425 (Jan 1 - June 30, 2021)Semi -Annual Statement of No Activity
Type or print in ink.
For use by recipient committees that have not received any contributions and have not made any expenditures
during the six-month period covered by a semi-annual statement. Candidate controlled committees formed for an
elective office may not use this form.
See the Information Manual on Campaign Disclosure Provisions of the Political Reform Act for additional information
and information required to be provided to you pursuant to the Information Practices Act of 1977.
MB
1. Committee Information
COMMITTEE NAME
Claremont Police Officers Association PAC
STREET ADDRESS (NO P.O. BOX)
570 W. Bonita Ave.
CITY STATE
ZIP CODE
AREA CODE/PHONE
Claremont CA
91711
909-399-5411
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET
P.O. Box 478
CITY STATE
ZIP CODE
AREACODE/PHONE
Claremont CA
91711
909-399-5411
OPTIONAL: FAX/ E-MAIL ADDRESS
2. Period of No Activity
5 Treasurer(s)
STATEMENT OF NO ACTIVITY
Date Stamp
ECEIVEW For Official Use Only
AUG 1 1 2021
CITY CLERK
NAME OF TREASURER
Jacob Tillman
MAILING ADDRESS
P.O. Box 478
CITY STATE ZIP CODE AREA CODE/PHONE
Claremont CA 91711 909-399-5422
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX/ E-MAIL ADDRESS
No contributions have been received and no expenditures have been made during the period covering the dates below:
Check one of the following boxes and complete the year. ® January 1, through June 30, 20 21 ❑ July 1, through December 31, 20
3. Verification
I have used all reasonable diligence in preparing this statement. I have reviewed the 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 the foregoing is true and correct.
8/2/21 By
Executed on
DATE SIGNATURE OF TREASURER/ASSISTANT TREASURER
FPPC Form 425 (Jan/01)
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