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410 Amended ~ Statement of Organization Recipient Committee o Tennination - See Pal List 1.0. number: print In Ink IX] Amendment List 1.0. number: # 1264630 'Jype or Initial o Not yet Statement Type CUPERTINO CITY CLEIRK # -----1-----1_ Date of Termination ~~~ Date qualified as oommittee (tløpplicable) or -----1---1_ Date qualified as committee o qualified Principal Officers "Penny") 2. Treasurer and Other NAME OF TREASURER Elizabeth L. Whittaker (aka STREET ADDRESS Committee Information NAME OF COMMITTEE City, a Primarily Formed Committee to Support Measures A, B, Save Our andC 1 AREA CODE/PHONE 408/255-8527 liP CODE 95014 STATE CA CITY STATE ZIP CODE Cupertino CA 95014 NAMEAND POSITION OF OTHER PRINCIPAl OFFIC""E'R(S):' IF APPLICABLE Dennis S. Whittaker CITY Cupertino NAME OF ASSISTANT TREASURER. IF ANY Kathey Holland STREET ADDRESS 20622 Cheryl Drive STREET ADDRESS (NO P.O. BOX) this address) AREA CODE/PHONE 408/255-8527 20622 Cheryl Drive CITY Cupertino MAILING ADDRESS (IF DIFFERENT) PO Box 1466, Cupertino, CA 95015 (PO Box is for donations oniy) OPTIONAL: FAX / E-MAIL ADDRESS matters to ZIP CODE 95014 (Send any governmental STATE CA AREA CODE/PHONE 408/996-0642 4081255-0259 COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE AREA CODE/PHONE 408/255-8527 ZIP CODE 95014 STATE CA MAILING ADDRESS 20622 Cheryl Drive CITY Cupertino Santa Clara Attach additional informatìon on appropriately labeled continuation sheets. 3. Verification I have used all reasonable diligence in preparing this statement and perjury under the laws of the State of California that the foregoing is on 8-/8- penalty of certify under to the best of my knowledge the information contained herein is true and complete. true and correct. By By o~ ~ ~-O'" DÄTË Executed STATE MEASURE PROPONENT Executed on SIGNATURE OF CONTROLUNG OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT Có-NTROLUNG OFFICEHOLDER, CANDIDATE, OR STATE MEAS-URE PROPONENT FPPC Fonn 410 (JanuaryI05) 866IASK·FPPC (866127~377Z) FPPC Toll-Free Helpline: SIGNATURE OF By By OATE OATE Executed on Executed on .0. NUMBER 1264630 ff candidate or officeholder controlled, also list the alective office sought or held. and Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMllTEE NAME Save Our City, a Primarily Formed Committee to Support Measures A, B, and C 4. Type of Committee Complete the applicable sections. Conl/Olled Committee · List the name of each controlling officeholder, candidate, or state measure proponent district number. if any, and the year of the election. affiliated or check Knon-partisan. list the name and identification number of the other · List the political party with which each officeholder or candidate is · If this committee acts jointly with another controlled committee, controlled committee. 1 1 10--- o Non-Partisan ElECTIVE OFFIC NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PRO committees only) located (controlled "candidate election' IS paign bank account · BANK ACCOUNT NUMBER STATE ZIP CODE - - to support or oppose specific candidates or measures in a single election. List below: AREA CODElPHONE CITY NAME OF FINANCiAl INSTITUTION ADDRESS CANOl ,-------- --- - ....',......"....".... SUPPORT OPPOSE Measure Regarding Housing Density (Measure A) Cupertino, CA IC SUPPORT OPPOSE Measure Regarding Buiiding Height (Measure B) Cupertino, CA IC Primarily formed CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO FPPC Form 410 (JanuarylO5) FPPC Toll-Free Helpline: 8Ø6/ASK,FPPC (8861275-3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE CQMMITIEE NAME Save Our City, a Primarily Formed Committee to Support Measures A, B, and C 4. Type of Committee Complete the applicabte sections. candidate or officeholder controlled, also list the elective office sought or held, and If check ~non-partÎsan. · List the name of each controlling officeholder, candidate, or state measure proponent. district number, if any, and the year of the election. List the political party with which each officeholder or candidate is affiliated or If this commijtee acts jointly with another controlled committee, · list the name and ,,,....,,..,,_........-.,...~,._. ,.~, ~.._... \"......LV..............,.u..... .n............,,, ".. ~'~..~w_1 I I 10-.- o Non-Partisan List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREA CODElPHQNE BANK ACCOUNT NUMBER ("'ITV ----- BANK ACCOUNT NUMBER ZIP CODE STATE AREA CODElPHQNE CITY NAME OF CANDIDAT ADDRESS · N · d '., .....,., ....."'v............ "............" ............_.../ I...MI:......"v"'<= SUPPORT OPPOSE Measure Regarding Building Setback (Measure C) Cupertino, CA It SUPPORT OPPOSE to support or oppose specific Primarily formed CANDIDATE(S) NAME OR FPPC Fonn 410 (JanuarylO5) FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3112) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME .0. NUMBER Save Our City, a Primarily Formed Committee to Support Measures A, B, and C 1264630 4. Type of Committee (Continued) Gene/al Purpose> COfJl/111tt('e Not formed to support or oppose specific candidates or measures in a single election. Check only one box: o CITY Comml1lee o COUNTY Comml_ o STATE Comml_ PROVIDE BRIEF DESCRJPTlON OF ACTIVITY Spons()fcd CorrJfmttee list additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE liP CODE Small Contnbuto, Como1/ttee o --1----1_ Check box and provide the date this committee qualified as a small contributor oommittee. If the committee qualified as a Date qualified small contributor committee on January 1,2001, enter 1/1101. 5. Termination Requirements By signing the verifICation, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certìfy that all of the following oonditions 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 flied all campaign statements required by the Political Reform Act disclosing all reportabie transactions. There are restrictions on the disposition of surplus campaign funds held by elected officers who are ieaving office and by defeated candidates. Refer to Government Code Section 89519. FPPC Fonn 410 (JanuaryI05) FPPC TolI·F"'e Helpline: B66/ASK·FPPC (866127$-3772)