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460 1st pre-election amendmentRecipientCommittee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period from 07/01 /09 through 09/19/09 1. Type Of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee ^ Ballot Measure Committee Q State Candidate Election Committee Q Primarily Formed Q Recall Q Controlled (AlsoCornpletePart5,1 Q Sponsored (Also Complete Part 6) ^ General Purpose Committee Q Sponsored Q Small Contributor Committee Q Political Party/Central Committee ^ Primarily Formed Candidatel Officeholder Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1319625 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Darcy Paul for Cupertino City council 2009 STREET ADDRESS (NO P.O. BOX) 20370 Town Center Lane, Suite 100 CITY STATE ZIP CODE AREA CODElPHONE Cupertino CA 95014 408 517 0977 MAILING ADDRESS (IF DIFFERENT) N0. AND STREET OR P.O. BOX Same CITY STATE ZIP CODE AREA CODElPHONE OPTIONAL: FAX ! E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviev~ing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 01/19/10 Date 01/19/10 Executed on Date Executed on Date Executed on Date By By Date of election if appli (Month, Day, Year) 11 /03/09 2. Type of Statement: ^ Preelection Statement ^ Semi-annual Statement ^ Termination Statement ® Amendment (Explain below) JAN 1 9 ~+~+ ~ ~ of _J r Official Use Only RTINO CITY CL RK ^ Quarterly Statement ^ Special Odd-Year Report ^ Supplemental Preelection Statement -Attach Form 495 Occupation and emploker information update Treasurers} NAME OF TREASURER Betsy Shoup 440-12 Galleria Drive CITY STATE ZIP CODE AREA CODE/PHONE San Jose CA 95134 408 517 0977 NAME OF ASSISTANT TREASURER. IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS ey Signature of Controlling Officeholder, Candidate, State Measure Proponent BY FPPC Form 460 (June/01) Signature of Controlling Officeholder, Candidate. State Measure Proponent FPPC Toll-Free Helpline: 866lASK-FPPC State of California COVER PAGE Recipient Committee Campaign Statement Cover Page -Part 2 Type or print in ink. 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Darcy Paul for Cupertino City Council 2009 OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Cupertino City Council RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 10100 Torre Avenue #140 Cupertino, CA 95014 Related Committees Not Included in this Statement: ~isranycommitrees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures ort behalf of your candidacy. COMMITTEE NAME I.D. NUMBER N/A NAME OF TREASURER CONTROLLED COMMITTEE? ^ YES ^ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER N/A NAME OP TREASURER CONTROLLED COMMITTEE? ^ YES ^ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) 6. Ballot Measure Committee COVER PAGE -PART 2 Page ~ of NAME OF BALLOT MEASURE N/A BALLOT NO.OR LETTER JURISDICTION ^ SUPPORT ^ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE. OR PROPONENT N/A OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ^ SUPPORT N/A ^ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ^ SUPPORT N/A ^ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ^ SUPPORT ^ OPPOSE N/A NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ^ SUPPORT ^ OPPOSE N/A CITY STATE ZIP CODE AREA GODS/YHONt Attach continuation sheets if necessary FPPC Form 460 (June/01} FPPC Toll-Free Helpline: 866lASK-FPPC State of California Schedule A Type or print in ink. SCHEDULE A Amounts may be rounded Monetary Contributions Received to whole dollars. Statement covers period • ~ ' 07/01/09 from . • 09/19/09 3 ~ through of page SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IFCOMMITTEE,ALSOENTERLD.NUMBER) CODE* jIF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF EUSINESS) 08/12/09 Tsung Hau Liu ~coM Retired 100.00 100.00 100.00 405 B Street ^ OTH Cheney, WA 99004 ^ PTY ^scc 08/14/09 Hsi I. and Grace Wan ~COM Retired 100.00 100.00 100.00 9604 Kentsdale ^OTH Potomac, MD 20854 ^ PTY ^scc 08/17/09 Kathy Chang and Kevin Chen ®^coM Researcher ' 110.00 110.00 110.00 1bU42 Valley Kldge ^OTH vJashinytuli iiiliVer3ity St. Louis, MO 63146 ^ PTY Medical Center ^scc 08/15/09 Jean C. Hsung OCoM Retired 100.00 100.00 100.00 5730 Pond Drive ^oTH Shoreview, MN 63146 ^ PTY ^scc 08/03/09 Angela Yang ~coM Retired 100.00 100.00 100.00 35494 Monterra ^OTH Union City, CA 94587 ^ PTY ^scc SUBTOTAL $ Schedule A Summary 1. Amount received this period -contributions of $100 or more. (Include all Schedule A subtotals.) .................................................................................................. 2. Amount received this period - unitemized contributions of less than $100 ....................................... 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $ 'Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other PTY- Political Party SCC-Small Contributor Committee FPPC Form 460 (June/01) FPPC Toit-Free Helpline: 866/ASK-FPPC