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1. Committee Information
NAME OF COMMITTEE
Orrin Mahoney for Council - 2009
STREET ADDRESS (NO P.Q. BOX)
10940 Miramonte Road
CITY STATE ZIP CODE AREA CODEIPHONE
Cupertino CA 95014 408-725-1767
MAILING ADDRESS (IF DIFFERENT)
P.O. Box 1071. Cuoertino. CA 95015
OPTIONAL: FAX / E-MAILADDRESS
COUNTY OF DOMICILE I COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Santa Clara
Attach additional information on appropriately labeled continuation sheets.
STATEMENT OF ORGANIZATION
~D AND FILED
the Secretary of StatE
ate of Calrfomta
JUL 2 7 2009
RA BOWEPI
Mary of State
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Carolyn Krizek-Mahoney
STREET ADDRESS (NO P.O. BOX)
10940 Miramonte Road
CITY
STATE ZIP CODE AREA CODE/PHONE
Cupertino CA 95014 408-725-1767
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
~~TV ~TnTC ~I°.~..~..~~ A°~r." vvvurnuv~.~
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
3. Verification
have used all 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 laws of the State of California that the foregoing is true ar
Executed on 7/24/2009 gy
Executed on 7/24/2009 By
DATE
Executed on By "
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on gy
GATE NATUR F N OLL N FFI H LD R, AN ATE, R STAT MEA U R N N
FPPC Forrn 410 (June/09)
FPPC Toll-Free Helpline: 888/ASK-FPPC (866/275-3772)
tatement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Orrin Mahoney for Council - 2009
4. Type of COn'1n11ttee Complete the applicable sections.
STATEMENT OF ORGANIZATION
Page 2
• 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 "non-partisan."
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME OFCANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Orrin Mahoney
Cupertino City Council
2009 ® Non-Partisan
^ Non-Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Wells Fargo Bank 408-863-6100 8123969811 checking / 5789650347 saving
ADDRESS CITY STATE ZIP CODE
10260 S. De Anza Blvd Cupertino CA 95014
- . . 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) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
FPPC Form 410 (June/09)
FPPC Toll-Free Helpllne: 866/ASK-FPPC (886/Z75.3772)
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee ~ • ' ~ ~
INSTRUCTIONS ON REVERSE
Orrin Mahoney for Council - 2009
4. Type of Committee (Continued)
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
^CITY Committee ^ COUNTY Committee ^ STATE Committee
Page 3
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
NAME OF
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE
^ _J-~
Date qualified
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent 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 (June/09)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)