410 Statement of Organization Recipient Committee - Termination Statement of Organization =�� � �aoa�a�,4b � . ,
Recipient Committee �} . v �� � _ � �
Statement Type ❑Initial r -
❑ Amendment � Termination-See Part 5 I For Official Use Only
Not yet qualified ❑ or List I.D.number. List I.D.number: J r; " �` �
�, 1381645 # 1381645
_�_� 12 �22 �2015 1�21 �2016 � �pFRTINO CITY CLE1�K
Date qualified as committee Date qualified as committee Date of Termination
(If applicable�
1. Committee Information 2. Treasurer and Other Principal Off'icers
NAMEOFCOMMITTEE Yes on C for Citizens. No on D for Developer. -Committee NAME OF TREASUREft
supporting Cupertino Citizens' Sensible Growth Initiative Xiaowen Wang
STREET ADDRE55(NO P.O.BOX) STREETADDRESS�NO P.O.BOX)
CIN STATE ZIPCODE AREACODE/PHONE CITY � STATE ZIPCODE AREACODE/PHONE
MAILING ADDRE55(IF DIFFERENT) NAME OF ASSISTANT TREASURER,IF ANY �
FAX/E-MAIL ADDRE55 STREET ADDRESS(NO P.O.BOX) '
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE CITY STA7E ZIP CODE AREA CODE/PHONE
Santa Clara I Cupertino, CA Xiangchen Xu
NAME OF PRINCIPALOFFICER(S)
STREET ADDRE55(NO P.O.80X) �
Attach additional information on appropriately labeled continuafion sheets.
CITV STATE ZIPCODE AREACODE/PHONE
3. Veriticati'on
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 that
Executed on gy
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Exetuted on gy
DATE SIGNATURE OF CONTROLIING 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 . � - .
Recipient Committee � - � �
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D.NUMBER
Yes on C for Citizens. No on D for Developer. -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 I AREA CODE/PHONE I BANK ACCOUNT NUMBER
ADDRE55 CITY STATE ZIPCODE
_. _ _._ .____ ... . .__ __ __. . _ ...._._ ._____ -_.._ .__. �_. ___ . _ . . . _ _ _..._. .____._.____ __.. . ___-__1
4.Type Of COmmittee Complete the applicable sections.
■4n uuallart��iuuuY��a�
• List the name of each controlling officeho�der,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 controtled 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
� � � � Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S)NAME OR MEASURE(5)FULL TITIE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(5)OFFICE SOUGHT OR HELD OR MEASURE(5)1URISDICTION
(WCW DE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) cHECK oNe
SUPPORT OPPOSE
Measure C City of Cupertino Q �
Measure D City of Cupertino S��T o� '
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
COMMITTEE NAME �I D NUMBEft
Yes on C for Citizens. No on D for Developer.-Committee supporting Cupertino Citizens' Sensible Growth Initiative I 1381645
4.Type of Committee (Continued) '
' � ' �� ' � Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CIN Committee ❑ COUNTY Committee❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY '
�.7.�.�,�.�.�.a,r1.,,.,,,�f.�a� List additional sponsors on an attachment.
NAME OF SPONSOR IINDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET AODRESS NO.AND STAEET CITY STATE ZIP CODE
� � • �
� �
Date qualified
5.T8ft171n8ttOt1 R@C�UICEfltelltS By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify that aIl 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.
FPPCForm 410(Dec/2012)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov