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465 Supp. Ind. Expend. Rept. supporting Mahoney 2/1/2010 upplemental Independent Expenditure Report (Government Code Section 84203.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be rounded to Report covers period whole dollars. ~ 10/18/2009 ( ) throw h 12/31/2009 ~ Amendment Explain Bebw 9 LD. NUMBER (If recipient committee) 1. CommitteelFiler Information 1299673 COMMITTEEIFILER'S NAME Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) CITY STATE ZIP CODE AREACODEIPHONE Cupertino CA, 95014 OPTIONAL: FAXIE-MAILADDRESS Date of election ii applic (Month, Day, Year) 11/03/2009 SUPPLEMENTALINDEPENDENTEXPENDITURE Date Stamp ~ , C~~i~~ ,I FEB -1 1010 1 of 3 Official Use Only t/~ I I TreaSUrer (Nreeipientcommittee) NAMEOFTREASURER Bob Adams CITY STATE ZIP CODE AREACODEIPHONE Cupertino CA, 95014 OPTIONAL: FAXIE-MAILADDRESS Z. Name of candidate or measure Supported or upposed CHECK ONE NAME OF CANDIDATE Orrin Mahoney NAME OF BALLOT MEASURE DISTRICT, IF APPLICABLE City Council Member City of Cupertino $. Independent EXpendltUreS Made Attach additionalin/ormation on appropdatelyla6eled continuation sheets. SUPPORT OPPOSE X SUPPORT OPPOSE CUMULATIVE TO DATE r ni win no vino DATE NAMEANDADDRESSOFPAYEE DESCRIPTION OF EXPENDITURE AMOUNT JAN.1-DEC~31 Robinson Communications Inc. Mailer 10/29/2009 Pacific Printing Postage for mailer to support Nihalani, 10/29/2009 Robinson Commun cations Inc. Pacific Printing Mailing services for mailer to support 10/29/2009 Inc. FPPC Form 465 FPPC Toll-Free Helpline: 8661ASK•FPPC (8661275.3772) upplemental Independent Expenditure Report SEE INSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be rounded to whole dollars. For use by an o~ceholder, candidate, or committee making independent expendRures totaling $500 or more in a calendar year to support or oppose a single candidate or a single measure. This form must be filed at the same times and places as the campaign statements filed by the candidate supported or opposed or by a committee primariy formed to support or oppose the measure. A separate form musl be filed for each candidate or measure being supported or opposed. This form is filed in addition to any other required campaign statements. Report covers period from 10/18/2009 through 12/31/2009 Date of election if applicable: (Month, Day, Year) 11/03/2009 Date SUPPLEIuFMAL IPDEPEhDEM DU~ETDIiURE Page? of 3 For Official Use Only Iv InaepenAe DATE ni tXpendltureS Made Attach additional information on appropnatelylabeled continuation sheets. cuMULATIVE ro DATE NAME AND ADDRESS OF PAYEE DESCRIPTION OF EXPENDITURE AMOUNT CALENDAR YEAR (JAN.1 -DEC. 31) 10/29/2009 Pacific Printing Printing for mailer to support Nihalani, Mahoney and Paul ISee Sch D) 550.73 MEMO Subpayment made Robinson Commun Inc. through: 'cations upplemental Independent Expenditure Report Type or print in ink. Amounts maybe rounded to whole dollars. 3) NAMEOFFILINGOFFICER from 10/18/2009 SEEINSTRUCTIONSONREVERSE through 12/31/2009 Page 3 of 3 NAME OF FILER I.D. NUMBER (If recipient com.) Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) 1299673 4. Summary 1. Total independent expenditures of $100 or more made this period. (Part 3.) ........................................................................................... $ 1, Toe, 06 2. Total independent expenditures under $100 made this period. (Not itemized.) ........................................................................................ $ o. 00 3. Total independent expenditures made this period (Add Lines 1 + 2.) .......................................................................................... TOTAL $ 1, Toe. 06 5. Filing OffICerS Enter the name and address of each filing officer with whom the f'iler's most recent campaign statements (Form 450, 460 or 461) have been filed. 1) NAME OFFILINGOFFICER City of Cupertino -City Clerk ADDRESS (N0. AND STREET) CITY STATE ZIP CODE Cupertino, CA 95014 2) NAMEOFFILINGOFFICER ADDRESS (N0. AND STREET) CITY STATE ZIP CODE ADDRESS SUPPLEMENTAL INDEPENDENT EXPENDITURE Report covers period (N0, AND STREET) CITY STATE ZIP CODE dl NAMFf1F GII INI:II[Fi~cc ADDRESS (N0. AND STREET) CITY STATE ZIP CODE 6. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury underthe laws of the State of California that the foregoing is true and correct. Executed on ~ ~t ~~ `' ATE `, I D Executed on DATE Executed on DATE Executed an DATE By -~ /~ = ~~ y SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT, OR RESPONSIBLE OFFICER OF SPONSOR By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT FPPC Form 465 FPPC Toll•Free Helpline: B661ASK-FPPC (8661275.3772)