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450 Recipient Committee Campaign Statement-Short Form ecipient Committee Type or print in ink. Campaign Statement -Short Form SEE INSTRUCTIONS ON REVERSE Statement covers period For use by recipient committees that have not received a from January 1, 2009 contribution or other receipt that must be itemized, have not received or made loans, and have no outstanding accrued June 30, 2009 expenses. through 1. Type of Recipient Committee: ^ Ballot Measure Committee ©General Purpose Committee Q Primarily Formed Q Sponsored ~ Controlled ~ Small Contributor Committee ~ Sponsored ^ Primarily Formed Candidate/ Officeholder Committee 3. Committee Information I.D. NUMBER 1287471 COMMITTEE NAME CONCERNED CITIZENS OF CUPERTINO STREET ADDRESS (NO P.O. BOX) 20850 Pepper Tree Lane CITY STATE ZIP CODE AREA CODE/PHONE Cupertino CA 95014 408.255.5175 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS ~jj !~ ~ ~~~ ~ I I l l I SHORT FORM L11 (--~-'O9c€St9m{s'~ - - - I ~ L 2 3 2009 I,J Date of election if appl cable: Page of _ (Month, D y, Yea For Official Use Only CU!'ER INO CITY CLERK 2. Type of Statement: ^ Pre-election Statement ^ Quarterly Statement © Semi-annual Statement ^ Special Odd-year Report ^ Termination Statement ^ Supplemental Pre-election Statement -Attach Form 495 ^ Amendment (Explain) (Also check type of statement you are amending) Treasurer(s) NAME OF TREASURER Marolyn O. Chow MAILING ADDRESS 21941 Columbus Avenue CITY STATE ZIP CODE AREA CODE/PHONE Cupertino CA 95014 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification have used all reasonable diligence in preparing and reviewing this statement and Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT, OR RESPONSIBLE OFFICER OF SPONSOR Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT FPPC Form 450 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/2753772) SHORT FORM Recipient Committee Type or print in ink. Amounts may be rounded Statement covers period ~ Campaign Statement to whole dollars. January 1, 2009 . - ~ t Summary Page from through June 30, 2009 page of NAME OF COMMITTEE I.D. NUMBER Expenditures Made 1. Expenditures of $100 or more made this period ..................................................................................................................................... $ 2. Expenditures under $100 made this period (Not itemized.) .................................................................................................................... 3. SUBTOTAL EXPENDITURES MADE THIS PERIOD ......................................................................................................................... Add Lines 1 + 2 $ 4. Nonmonetary Adjustment .......................................................................................................................................... From Line 8 Below 5. Total expenditures made from previous statement ............................................................................... Previous Summary Page, Line 6 $ (If this is the first statement for the calendar year, enter zero.) 6. TOTAL EXPENDITURES MADE TO DATE .................................................................................................................................. Add Lines 3 + 4 + 5 $ 1287471 Contributions Received 7. Monetary contributions received this period ........................................................................................................................................... $ 25.00 8. Non-monetary contributions received this period .................................................................................................................................... 9. Total contributions received from previous statement ......................................................................... Previous Summary Page, Line 10 $ 25.00 (If this is the first statement for the calendar year, enter zero.) 10. TOTAL CONTRIBUTIONS RECEIVED TO DATE ......................................................................................................................... Add Lines 7 + 8 + 9 $ 25.00 Current Cash Statement 11. Beginning cash balance ..................................................................................................................... Previous Summary Page, Line 15 $ 1,030.51 12. Cash receipts this period .................................................................................................................................................... Line 7 above 25.00 13. Miscellaneous increases to cash ............................................................................................................................................................ $ 0 14. Cash expenditures this period ............................................................................................................................................ Line 3 above 0 15. ENDING CASH BALANCE THIS PERIOD ..................................................................................... Add Lines 11 + 12 + 13, then subtract Line 14 $ 1,055.51 FPPC Form 450 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)