HomeMy WebLinkAboutForm 410 - Amendment - Chou, Andrew - 2021.12.15statement of Organization
Recipient Committee
Statement Type [U Initial
Date Stamp CALIFORNIA
FORM 410
O Not yet qualified
0 Amendment D Termination - See Part 5 For Official Use Only
or
O Date qualification threshold met Date of terminationDate qualification threshold met
20211129 y.I I
2. Treasurer and Other Principal Officers1. Committee Information I I.D. Number 1440052
{!!applicoblel
NAM£ OFCOMMITTEe NAME OF TREASURER
Andrew Chou for Diamond Bar City Council 2022 Andrew Chou
STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS (NO P.O. BOX)AREACOOE/PHONECITYSTATEZIPCODE
Diamond Bar CA 91765
CITY STATE AREA CODE/PHONEZIP CODE NAME OF ASSISTANT TREASURER, IF ANY
Diamond Bar 1317CA91765
STREET ADDRESS (NO P.O. BOX)FULL MAILING ADDRESS (IF DIFFERENT)
ZIPCODE AREA CODE/PHONEE-MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL)
CITY STATE
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)
AREACOOE/PHONECITYSTATEZIPCODE
Attach additional information on appropriately labeled continuation sheets.
3. Verification
I have used all reasonable diligence in preparing this statement and to the^est 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 thie foreraing is true and correct.
Executed on
v?/12/01/2021
By
DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER)
12/1/2021Executed on
^GN^RR
By
DATE E OF CONTROLLING OFFICEHOLDER, CANDIDATE, OH 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: advIceOfppc.ca.gov (866/275-37721
www.fppc.ca.gov
statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
CALiFORNIA
FORM 410
Page 2
COMMIHEE NAME I.D. NUMBER
Andrew Chou for Diamond Bar City Council 2022 1440052
l All committees must list the financial Institution where the campaign bank account is located.
AREA CODE/PHONE BANK ACCOUNT NUMBERNAME OF FINANCIALINSTITUTION
Wells Fargo
CITY STATEADDRESS ZIP CODE
Diamond Bar CA 91765
4. Type of Committee Complete the applicable sections.
Controlled Committee
l 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
/
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.
CANOIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)CHECKONE
SUPPORT OPPOSE
SUPPORT OPPOSE
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
CALIFORNIA
FORM 410
Page 3
COMMITTEE NAME I.O. NUMBER
Andrew Chou for Diamond Bar City Council 2022 1440052
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:
□ STATE CommitteeD CITY Committee □ COUNTY Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.Sponsored Committee
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
AREA CODE/PHONESTREET ADDRESS NO. AND STREET STATE ZIP CODECITY
□Small Contributor Committee J.J.
Date qualified
5. Termination Requirements By signing the vGrific.ition, 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: advice@fDPC.ca.gov (866/275-37721
www.fDPc.ca.gov