410 Statement of Organization Recipient Committee - Amendment to change name Statement of Organization � D e m • _ , t
Recipient Committee • "
Statement Type ❑Initial ❑ Amendment ❑ Termination—See Part 5 q F°`°�;`�ai u`r o"i�
List I.D.number: List I.D.number: S E P — 7 ��16
Not yet qualified ❑ or
# 1381645 �
� � 12 �22 �2015 � � CU�ERTINO C1TY CLERK
Date qualifed as Committee Date qualified as committee Date of Termination
(If.�pplicable�
1. Committee Information 2. Treasurerand Other Principal Officers
NAME Of COMMITILE Yes on C for Citizens. No on D for Developer. -Committee NAME OF THEASURf�.R
supporting Cupertino Citizens' Sensible Growth Initiative
si r.[er nnoai.ss(No p,o.uoxl si itrer AooHess(No a.o.nox)
CITV STAI1�. /IPCODE /1HEAC.OUC/PFIONI. CITV STATE ZIPCODE P.RFACUD[/PHpNE
MAILING�DDRE55(I{I)II�FI RLNI) N�M[OF ASSISTANT TREASURER,IF ANY
FA%/E-MAIL ADDRFSS SI HEET ADDRESS(NO PD.BOX)
COUNTVOfDOMICILE IIURISDIC110NWH1-_RI�COMMITTE[IS�CTIVI: CITV tiiATl /IP((71�L ARf�COIJL/PHON[ ,
NAML Of PRINCIPAI.OFFIG[R�S)
SIItI�.LI AI�I11iI�SSINI]P.().fi0x1
Attach additional information on appropriately labeled continuation sheets.
CITY STATE LIPCODE ARFACODE/PHnNE
3. Veriticafion
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
R
�/ ;` �� "
Executed on � '-!/ By ,='� % , ! _ ���`
� � �ATE � � SIGN�IURI:OfCONTROLLINGOFfICEHOLDFR,CANDIDAIt,ORSTATEMEASUREPR01'ONENT
Executed on By '
DATE SIGNATUftE OF CONTROLLING OfFICEI�IOLDER,CANDIDATE,OR STATE MEASURE PROI'ONfNI�
Executed on By
OATE SIGNATUHF OF CONI ROLLING OFFICFHOLO[R,CANDIDATF,OR STATE Mf�SUR[PROPONI-Nl
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 2
COMMITTFE NAME
I.D.NUM[�ER
Yes on C for Citizens. No on D for Developer. -Committee supporting Cupertino Citizens' Sensible Growth Initiative 1381645
• AII committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AR[�COUI:/NHONt I pqNK ACCOUN7 NUMBFR �
ADDR[55 CITY STATE ZIPCODE
4.Type of Committee Complete the applicable sections. '
��.�u�u�1 l a.Y�.�i n u i l�ta:�
• List the name of each controlling oHiceholder,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
❑ Nonpartisan
❑ Nonpartisan
■��i�,�.�.u.�.�.,ua•t�.uu„��„a� Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(51 NAME OR MEASURE(S)FULLTITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(5)JURISDICTION
(WCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPVORT OPPOSE
Measure C City of Cupertino � �
Measure D City of Cupertino SI� �
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
comMirie�Nnme
I.D.NUM6ER
Yes on C for Citizens. No on D for Developer.-Committee supporting Cupertino Citizens' Sensible Growth Initiative 1381645
4.Type of Committee (Continued)
Not formed to support or oppose specific candidates or measures in a single election. Checl<only one box:
❑ CITY Committee ❑ COUNTY Committee❑ STATE Committee
�ROVIIJ[6RIE�lJCS('RIPTION Of-ACTIVITY •
��•�����•y�-�a�r�•��������++a; List additional sponsors on an attachment.
NAME OF SPONSOR IINDUSiNV GROUP OR AffILIATION O�SPONSOR
STREET ADDRESS NO.AND STREET CITV STATE Zlf'CODE
❑ � �
Datc qualified
5.Termination Requirements By signing the verificatlon,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify that all of the following conditlons have been met:
• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or mal<ing 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.
FPPCForm 410(Dec/2012)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov