HomeMy WebLinkAboutForm 410 - Initial - Chou, Andrew - 2021.07.27statement of Organization
Recipient Committee
statement Type SI Initial
Date Stamp CALIFORNIA
FORM
0 Not yet qualiflad
n Amendment D Termination - See Part 5 For Official Use Only
or
O Date qualification threshold met Date of terminationDate qualification threshold met
I I y.i
1. Treasurer and Other Principal Officersi.D. Number1. Committee Information
df appUcahki
NAMEOFCOMMIHEE NAME OF TREASURER
Andrew Chou for Diamond Bar City Council 2022 Andrew Chou
STREET ADDRESS {NO P.O. UOX)
STREET ADDRESS (NO P.O. BOX)CITY AREA CODE/PHONESTATEZIP CODE
Diamond Bar CA 91765
CITY STATE ZIP CODE AREACOOE/PHONE NAME Of ASSISTANT TREASURER, IF ANY
Diamond Bar CA 131791765
FULL MAILING ADDRESS (IF DIFFERENT)STREET ADDRESS (NO P.O. BOX)
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
CITY STATE ZIP CODE AREA CODE/PHONE
Diamond Bar CA 91765
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
Los Angeles City of Diamond Bar
STREET ADDRESS (NO P.O. BOX)
CITY AREA CODE/PHONESTATEZIP CODE
Attach additional information on appropriately labeled continuation sheets.
3. Verification
i have used ail reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury under the taws of the State of California that the
07/27/2021
ina4s true and correct.
E Bxecuted on y
l ATE aURE OF TREASURER OH ASSISTANT TREASURER
V'P7 DATE
Executed on By
ITROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advicefSfppc.ca.eov (866/275-3772)
www.fopc.ca.gov
statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
CALIFORNiA
FORM 410
Pages
COMMITTEE NAME I.D. NUMBER
Andrew Chou for Diamond Bar City Council 2022 ’pending
l All committees must list the financial institution where the campaign bank account is iocated.
BANK ACCOUNT NUMBERAREACODE/PHONENAME OF FINANCIAL INSTITUTION
Wells Fargo ’pending909<
CITY STATE ZIP CODEADDRESS
Diamond Bar CA 91765
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.
l List the political party with which each officeholder or candidate is affiliated or check "nonpartisan."' Stating "No party preference" is acceptable
l 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
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF
ELECTION
PARTY
CHECK ONENAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
(list political party below)Nonpartisan PartisanAndrew Chou City Council 2022
/
(list political party below)Nonpartisan Partisan
Primarily formed to support or oppose specific candidates or measures in a single election. List below:Primarily Formed Committee
CANDIOATE(S) NAME OR MEA5URE(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($] JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice(a>fppc.ca.eov (866/275-3772)
www.fDPC.ca.eov
statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
CALIFORNIA
FORM 410
Pages
COMMITTEE NAME I.D. NUMBER
4. 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;
D STATE Committee□ CITY Committee □ COUNTY Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachmentSponsored Committee
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO. AND STREET AREA COOE/PHONECITYSTATEZIP CODE
Small Contributor Committee □y.y.
Date quallUtd
5. 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 ail 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 fo r 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: advicei^fppc.ca.eov (866/275-3772)
www.fDDc.ca.gov