410 Statement of Organization Recipient Committee – Amendment Qualified stamped by SOS Statement of Organization Date Stamp
9 CALIFORNIA A 1 O
M
'i
Recipient Committee FOR
Statement Type 0 Initial 121 Amendment 0 Termination—See Part 5 RECEIVED AND FILED ' C (a0 cal 'a.�!'!p�
j
Slotyet qualified 0 or List I.D.number: List I.D.number: Mite office of the Secretary of State - u
1381645 of the Sem of Califomla
12 22 2015 # !JAN 11 2016 - JAN 2 6 2016
Date qualified as committee Date qualified as committee Date of Termination
(Ir PPlkabl., UPERTINO CITY r.: Fg,v
J.=;)Comniittee fnfo matlonal >' 4,aa,-;itx. : , ""`v '*g am '^ ' "r''i,2:=xireasuger4a d etherFPrincipaliaff cek ., ,e "i rr4rale o P;;; "
NAME OF COMMITTEE NAME OF TREASURER
Committee supporting Cupertino Citizens' Sensible Growth Initiaf'trtre
STREET ADDRESS(NO P.O.BOX) STREET ADDRESS(NO P.0.00X)
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
MAILING ADDRESS(IF DIFFERENT) NAME OF ASSISTANT TREASURER,IF ANY
FAX/E-MAIL ADDRESS - STREET ADDRESS(NO P.O.BOX)
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS(NO P.O.BOX)
Attach additional information on appropriately labeled continuation sheets.
CITY STATE ZIP CODE AREA CODE/PHONE
13.;; Ver,if tatibt:U I 4 .. ?.o...:t_C.V J;,.. ..:eX' :az.,7-1aa^ .• 1't+ ' s.T s ---- Sid
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 jaws of the State of Cr ' orn'a that the foregoing is true and correct.
Executed on Pi d /20 l By
DATE
CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(Dec/2012)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA 41 0
Recipient Committee FORM
•
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I .NUMBER
Committee supporting Cupertino Citizens' Sensible Growth Initiative 1381645
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Wells Fargo
ADDRESS CITY STATE ZIP CODE
/ (u/erfho (i9 f52/y
4^T eJ'Of Gomrnitfiee Coete. hea lira• eTseGtlon -t �- ' �
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Cantr'dlle"d.Comnii&ee
• 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"nonpartisan."
• If this committee acts jointly with another controlled committee,list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SMB
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
(INCLUDE DISTRICT NUMBERER IF
OR HELD
F APPLICABLE) YEAR OF ELECTION PARTY
❑ Nonpartisan
❑ Nonpartisan
,P. imaiily`Formed'committee 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
SI PPOR Orsi
FPPC Form 410(Dec/2012)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA 41 0
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D.NUMBER
Committee supporting Cupertino Citizens' Sensible Growth Initiative 1381645
I i t O. .. „�..SM C I .ay M1ALF' 4'xfa`.. P 5 a''"� i"y A .F +6
..Ty e-dfComrnittee { nt, ded �: - „• _ .F �, ,� -;� t�
�. J' _ .. . '” I ".^ rl 'l � `�i+ ,� ^, , =5r "g °r 3%". v�'..'fE -
�� � .xe0.`v is`iNla�.uulx.� � �l.K...e
s•~Gene-roPo?pose committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee 0 COUNTY Committee 0 STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponso"fed committee List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE
'ISmallr6,_o"mrifittor.Co'mmittee
--/�
Date qualified I �t p I
-.g n - N x'ti n:g an a^ a x ^; I y_;"w e e•..:ygR�-P.lOrl-rw'yp+'f(dytStlVdad.i.l/ ReWialli itUlattb 714.i 2 eter-,.-�;.¢.`+:
5:;�Tefmil7ation�Re(gUlr�emelA'�s�a 6 I:nln the veri iation the'reas,�er5as'sista'rivtiea5ure nd)or ca'�` Ida,SSe;officeholderr,SSG�a Po Dnent,ce �I-o I efo s•
• 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(Dec/2012)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
• DATE: January 7, 2016
TO: Secretary of State
Political Reform Division
1500 11th Street, Rm 495
Sacramento, CA 95814
FROM: Committee supporting Cupertino Citizens' Sensible Growth Initiative
P.O. Box 1132
Cupertino, CA 95015-1132
FPPC#1381645
We paid our$50 annual fee when we filed our initial paperwork dated December 14, 2015.
Thank you,
Xiaowen Wang,Treasurer