HomeMy Public PortalAbout03. Form 410 TerminationStatement of Organization
Date Stamp
CALIFORNIA 410
IVca.1N1 1n v
Statement Type
1. Committee
aac a. ■
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SEP 1 1 2023
CITY CLERK
OF CLAREMONT
For Official Use Only
• Initial
threshold met
■ Amendment
J Termination — See Part 5
Date of termination
08 / 03 / 2023 CITY
Q Not yet qualified
Or
O Date qualification
-__/-✓
Information
Date qualification threshold met
I.D. Number
C a. •licable
__/—/
1423232
2. Treasurer and Other Principal Officers
NAME OF COMMITTEE
Rachel Forester for Claremont City Council District One 2020
NAME OF TREASURER
Bonnie F. Emadi
STREET ADDRESS (NO P.O. BOX)
4205 Oak Hollow Rd.
STREET ADDRESS (NO P.O. BOX)
660 W. Bonita Ave., Apt. 19F
CITY STATE ZIP CODE
Claremont CA 91711
AREA CODE/PHONE
(909) 451-1904
CITY STATE ZIP CODE AREA CODE/PHONE
Claremont CA 91711 (951) 533-2806
NAME OF ASSISTANT TREASURER, IF ANY
N/A
FULL MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
E-MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL)
CITY STATE ZIP CODE
AREA CODE/PHONE
COUNTY OF DOMICILE
Los Angeles
JURISDICTION WHERE COMMITTEE I5 ACTIVE
City of Claremont, California
NAME OF PRINCIPAL OFFICER(S)
Jeena Trexler-Sousa
Attach additional information on appropriately labeled continuation sheets.
STREET ADDRESS (NO P.O. BOX)
444 7th Street
CITY STATE ZIP CODE
Claremont CA 91711
AREA CODE/PHONE
(909) 870-8240
3. Verification
.� t.. .. l
have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein Is true and complete.
penalty of perjury under the laws of the State of Ca jfornia that the foregoing is true and correct.
Executed on ?/11/7'1113 By
/1Q/DATE
Executed on 8l ` t r 2916 By
DATE
Executed on By
DATE
Executed on By
GATE
IGNATURE OF TREASURER OR ASSISTANT TREASURER
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, 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: advicePfppc.ca.sov (866/275-3772)
www.fppc.ca.eov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
CALIFORNIA 410
FORM
Page 2
COMMITTEE NAME
Rachel Forester for Claremont City Council District One 2020
I.D. NUMBER
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
Bank of America
AREA CODE/PHONE
(909) 451-0974
BANK ACCOUNT NUMBER
3251 3542 9972
ADDRESS
339 Yale Ave.
CITY
Claremont
STATE
CA
ZIP CODE
91711
4. Type of Committee Complete the applicable sections.
Controlled Committee
• 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.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF
ELECTION
PARTY
CHECK ONE
Rachel Leigh Forester
City Council
2020
Nonpartisan
Partisan
(list political party below)
Nonpartisan
Partisan
(list political party below)
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)
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
SUPPORT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice(fppc.ca.eov (866/275-3772)
www.fppc.ca.Rov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
CALIFORNIA 410
FORM
Page 3
COMMITTEE NAME
I.D. NUMBER
. Type of Committee
(Continued)
General Purpose Committee
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee 0 COUNTY Committee 0 STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored Committee
List additional sponsors on an attachment.
NAME OF SPONSOR
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS
NO. AND STREET
CITY
STATE
ZIP CODE AREA CODE/PHONE
Small Contributor Committee
0
Date qualified
. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or ponent certify that all of the following conditions have 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: adviceC'fooc.ca.aov (866/275-3772)
www.fppc.ca.eov