410 Statement of Organization Recipient Committee - Amendment Stamped by SOS ae
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Stwiement of Organization DateStamp
�ecipient Committee
Statement Type ��nitial �Amendment ❑ Termination—See Part 5 For Official Use Only
Notyetqualified ❑ or Listl.D.number: Listl.D.number: � � �r
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Datequalifiedascommittee Datequalfiedascommittee DateofTermination ��� � (� ��'��. �%UPERTINO CITY CLER!�� '
(If applicable)
1. Committee Information - ° 2. Treasurer and Ot�er Principal 0fficers
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....NAME OF COMMITTEE .,,.. .. .... ...,. ,.... ..._.. .��..... _.__. ,.... .. , r ,:.5„, .�:�:,
���� ^ (�— ^ NAME OF TREASURER ����� ��
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C��„'/��61 p 1 ryA �/,y I�C�� ' /O�p n STRE[TADDRESS(NOP.O.BOX) '
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STREET ADDRESS(NO P.O.80X) CITY STATE ZIP CODE AREA CODE/PHONE
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CITY STATE ZIPCODE AREACODE/PHONE NAMEOFASSISTANTTREASURER,II'ANY '
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MAILING ADDRESS(IF DIFFERENT) � STREETADDRE55(NO P.0.80X) '
FA%/E-MAIL ADDRESS '
COUNTY OF DOMICILE lURISDICT10N WHERE COMMITTEE IS ACTIVE NAME OF PRWCIPAL OFFICERIS) '
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C��y I'�'�J� ��n'�/� .�/ STNEET ADDRESS(NO P,O.BOX) '
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CITY STATE ZIPCODE AREACODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
3. Verification �
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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
Of TREASURER OR ASSISTANT TREASURER �
Executed on ov o� I/�� gY �
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASUR[PROPONLNT �
Executed on gy
DAT[ SIGNATURE OF CONTROLLING OFfICEHOLDER,CANDIDATE,ORSTATE MEASURE PROPONENT
Executed on gY
DAiE SIGNATUREOf-CONTROLLING OFRCEHOLDER,CANDIDATE,ORSTATE MEASUREPROPON[NT �
FPPC Form 410(1an/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
St�tement of Organization . � _
ftecipient Committee � �
• -
INSTRUCTIONSON REVERSE
Page 2
COMMIiTEE NAME
F��G • "�`��� � � � 1 ' CV V� I C I I L�� �� I.U.NUMBER
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• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIALINSTITUTION AREACODE/PHONE OANKACCOUNTNUMeER
W�Ils�rqo �Gl�lk I � I � � ) .
nooHess
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4.T peofiC ��
orTlmittee Complete the�ppEicabf�sections: °
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lN�ui�nilla.r�.iiuwlna� � .. ._.. .._. . ..... __... _._. ......
• 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 Of-FICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
A
�l/�� �W I Vi�V vv� � ����1� (V ` � � -I C'V'�d�C� 9 �`-' U � �-' "onpartisan
B
❑ Nonpartisan
�•��%�����i�•���•;,�a•r�•�„�„�i,�=��� primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S)NAME OR MEASURE(5)FULLTITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE�S)JURISDIC710N
(INCLU DE DISTRICT PJO.,CITY OR COUNTY,AS APPLICAQLE� CHECK oNc
ISUPPORT OPPOSE
I SUPPORT OPPOSE
_ ❑ ❑
FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov