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410 Statement of Organization Recipient Committee - Initial not yet qualified (Stamped by SOS)t Statement of Organization Recipient Committee Statement Type 0 Initial ❑ Amendment ❑ Termination —See Part 5 Not yet qualified ® or List I.D. number: List I.D. number; 1. Committee I NAME OF COMMITTEE Date qualified as committee rmation Date qualified as committee Date of Termination (If applicable) Cupertino Residents for Sensible Zoning Action Committee STREET ADDRESS (NO P.O. BOX) MAILING ADDRESS (IF DIFFERENT) FAX / E -MAIL ADDRESS COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE 15 ACTIVE Santa Clara County Cupertino, CA Attach additional information on appropriately labeled continuation sheets. Date Stamp Fi Li' :D in the office of the Secre of the State of Cali 2. Treasurer and Other Principa NAME OF TREASURER Liang -Fang Chao ,.1 MAR 172015 COPERTINO CITY CLERK STREET ADDRESS (NO P.O. BOX) CITY STATE ZIPCODE AREACODE /PHONE NAME OF PRINCIPAL OFFICER(S) Liang -Fang Chao STREET ADDRESS (NO P.O, BOX) 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 Ca 'fornia that,*e7oregoing is true and correct. Executed on _DATF By 1 / �� CANDIDATE, OR STATE MEASURE PROPONENT Executed on DATE Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By 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 Recipient Committee FORM 0 INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME Cupertino Residents for Sensible Zoning Action Committee 1. D. NUMBER • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER Pending ID # ADDRESS 4. Type of Committee Complete the applicable sections. CITY STATE ZIPCODE • 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. NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Formed Primarily 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 ItMn i in[ nicro�rr nin Iry ., FPPC Form 410(Dec /2012) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov CHECKONE SUPPORT OPPOSE SU PPO 0E2EQLE FPPC Form 410(Dec /2012) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 3 Cupertino Residents for Sensible Zoning Action Committee I.D. NUI 4. Type of Committee (Continued) General Purpose Com mittee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: O CITY Committee ❑ COUNTY Committee ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY We Sponsored Committee are focused on engaging residents and our city government to balance growth and quality of life for residents of Cupertino. List additional sponsors on an attachment. NAME OF SPONSOR STREET ADDRESS NO. AND STREET CITY Smell Contributor Committee ■ Date qualified INDUSTRY GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE S. 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(Dec/2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov