410 Statement of Organization Recipient Committee - Termination Stamped by SOS ` s
Statement of Organization
Recipient Committee
Statement Type ❑Initial
Nat yet qualified ❑ or
Date qualified
❑ Amendment
List I.D.number:
# 1381645
12 122 12015
Date qualified as committee
(If applicable)
® Termination—See Part 5
List I.D.number:
# 1381645
12 /21 /2016
Date of Termination
Date S a
CEIVE® FILE
in t to of th$Std of califomia f 5i,
DEC 27. 2016
JAN 1 1 2017
r rr II
1. ,Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE - - p •?ti;i�, ,,¢ a..
Yes on C for Citizens. No on D for Developer.-Committee NAME OF TREASURER
supporting Cupertino Citizens' Sensible Growth Initiative Xiaowen Wang
STREET ADDRESS(NO P.O.BOX) STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP COD
MAILING ADDRESS(IF DIFFERENT)
FAX/E-MAIL ADDRESS
w VN I Y or DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Santa Clara Cupertino, CA
Attach additional information on appropriately labeled continuation sheets.
E AREA CODE/PHONE
NAME OF ASSISTANT TREASURER,IF ANY
STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Xiangchen Xu
NAME OF PRINCIPAL OFFICER(S)
ST REET ADDRESS(NO P.O.BOX)
uIY I STATE ZIP CODE AREA CODE/PHONE
3:.I have us
dOn reasonable diligence In preparing this statement o the best of m p y
p p g nt and t y knowledge the information contained herein Is true and complete. I certify under
penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on By `
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(8661275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
rl
INSTRUCTIONS ON REVERSE
COMMITTEE NAME es on C for Citizens. No on D for Developer.-Committee supporting Cupertino Citizens' Sensible Growth Initiative
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
AREA CODE PHONE BANK ACCOUNT NUMBER
ADDRESS
CITY STATE ZIP CODE
4. type of Committee Complete the appllca,bleYsections
y $
_ IS
• 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 CAN DI DATE/OFFICE HOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
❑ Nonpartisan
❑ Nonpartisan
Primarily Formed Committee i.
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) CAN DIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
Measure C City of Cupertino SUPPORT
WL El
OPPOSE
Measure.D SU T O
City of Cupertino ] ryl
FPPC Form 410(Dec/2012)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA
Recipient Committee
INSTRUCTIONS ON REVERSE FORM 410
Page 3
COMMITTEE NAME
I.D.NUMBER
Yes on C for Citizens. No on D for Developer.-Committee supporting Cupertino Citizens' Sensible Growth Initiative 1381645
4.Type`of Committee (Continued)
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE
Small Contributor Committee
Date Qualified
S.Termination Requirements By signing the verification,the treasurer,assistant treasurerand/or candidate ro P ofhceholdeC or onent cerl that all,,of the following conditions have been met:
p n
• 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 maybe 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