410 Initial Statement of Organization
Statement of Organization STATEMENT OF ORGANIZATION
Reci lent Committee Type or print in ink ~ m
p D~~~~~~ ~ 1
Statement Type ®Initial ? Amendment ? Termination -See For Offidal use onry
Not yet qualfied ? or List I.D. number: List I.D. number: u ~ 2 ~ L~~9
# #
16 ~ os CUPE TINO CITY CLERK
Date qualified as wmmittee Date qualified as committee Date of Termination
(ff applicable)
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF TREASURER
Orrin Mahoney for Council - 2009 Carolyn Krizek-Mahoney
STREET ADDRESS (NO P.O. BOX)
10940 Miramonte Road
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE
10940 Miramonte Road Cupertino CA 95014 408-725-1767
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
Cupertino CA 95014 408-725-1767
STREET ADDRESS (NO P.O. BOX)
MAILING ADDRESS (IF DIFFERENT)
P.O. Box 1071. Cupertino. CA 95015 r•iTV RTATF 71P OODF AREA CCIDF/PHnNF
OPTIONAL: FAX I E-MAIL ADDRESS
NAME OF PRINCIPAL OFFICER(S)
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE STREET ADDRESS (NO P.O. BOX)
Santa Clara
CITY STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
3. Verification
I have used all reasonable diligence in preparing this statement and to the best
Executed on By
DATE SIGNATURESOF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF C NTROLLING FFICEHOLDER, CAND A E, OR TAT MEASUR PR P N NT
FPPC Form 410 (June/09)
FPPC Toll-Free Helpline: 888IASK-FPPC (8661275-3772)
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee • ' ~ ~
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D. NUMBER
Orrin Mahoney for Council - 2009
4. Type Of COmmlttee Complete the applicable sections.
.
• 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."
• tf this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
® Non-Partisan
Orrin Mahoney Cupertino City Council 2009
? 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
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (June/09)
FPPC ToIFFree Helpllne: 886/ASK-FPPC 1866/275-3772)
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee • ' ~ ~
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D. NUMBER
Omn 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
PROVIDE BRIEF DESCRIPTION OF ACTNfTY
. • . . List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE
. . r .
? ~~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 ToIMFree Helpline: 885/ASK-FPPC (8661275-3772)