410 Initial Statement of Organization tatement of Organization
Recipient Committee
Statement Type ~~nitial
Notyetqualified ^ or
~~ ? ~~~
Date qualified as committee
1. Committee Information
Type or print in ink
^ Amendment
List I.D. number:
Date qualified as committee
(If applicable)
^ Termination -See Part 5
List I.D. number:
D eat of~ation
Date Stamp
J U L 2 4 2009
UPERTINO CITY C
2. Treasurer and Other Principal Officers
STATEMENT OF ORGANIZATION
NAME OF COMMITTEE
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
MAILINGADDRESS (IF DIFFERENT)
OPTIONAL: FAX t E-MAILADDRESS
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Ci..~Jk1R-r~~
Attach additional information on appropriately labeled continuation sheets.
NAME OF TREASURER
STREETADDRESS (NO P.O. BOX)
l 9 Y ~ 7 f~~~ .~r Cr~z.~< r3~~~
CITY STATE ZIP CODE AREA CODE/PHONE
C~.c~'Jp_n~i/1J ~i/7 Cd`.~®/~~ ~'~pT~'77.~-/~f~7
NAMEgFASSISTANTTREASURER, IF ANY
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE AREA CODE/PHONE
3. Verification
I 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 _ ~/~-`/~~ By
DATEr,,
Executed on ~~ .~--~ Q '"I By
~- DATE
Executed on
DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (June/09)
FPPC Toll-Free Helpline: 866tASK-FPPC (8661275-3772)
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT