410 Statement of Organization Recipient Committee – Amendment – Stamped by SOS Staternent of Organizatian DateStamp � � . � , ,
F�ecipient Committee
Stateme�nt Type ❑ Initial � Amendment ❑ Termination—See Part 5 � � r(� Yial se �
Notyetqualified ❑ or List I.D.number: List I.o.number: ��CEIVED AND �ILE ' ,J �
# 1383579 # in t te of6ae of the 3ec�etary of Sta +� �
06 21 2016 of the Sta1e of G�lifnmia ,��- � � �U�� ; J
i i .l l l l �f��� �'�:2���1� `
Date qualified as committee q � PP ' of rermination �UPERTlNO CITY �
Date uali ed as committee Date
If a licable I �
,... ... '�.s.- , 'El,d.'7.���a �,pw^:�'.'Ni '. m`'� .x ^G ^'.J"nMN���1r r, x —
1 �Qr�iir�ittee nfdh ,<,., .. .,., . . ,, �° ��w �p �i"k, , , .:.F� _
,� „ �
, ,�,�, w ��,,� . . . _2. Treas�urer'and (�`�, �r'�r��n i .al� ,.:Cers , -�e�;: , <,, � <�,_ ,
• NAMEOFCOMMITTEE � � NAME OF TREASURER � ��
David Fung for City Council 2016 Kathy Jacques
STREET ADDRE55(NO P.O.BOX)
STREEi ADDRE55(NO P.O.BOX) CITY STATE � ZIP CODE AREA CODE/PHONE
CITV STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TftEASURER,IF ANY
Cupertino CA 95014 (
MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O.BOX)
FAR/IE-MAILADDRESS CITY STATE ZIPCODE AREACODE/PHON[
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTE�IS ACTIVE NAME OF PRINCIPAL OFFICERIS)
Santa Clara ICupertino, CA
STREET ADDRESS(NO P.O.BO%)
QTY STATE ZIP CODE AREA COU@/PHONE
Attach additional information on appropriately labeled continuation sheets.
�y �}�yj�'}'� �,.,� i ... �71 �. M T MY lln �' �..
3• .T:��l.'11�C47�'��:_.,.6.�! .f�..:. ,r��,.�t..�..:u}..a... wn��.a `.._ :. ... . : �� .f � . . �.i.::L _ t ,t , � .
1
I have used all reasonable dili ence in re arin this statement and to the best of m knowled e the inform
g p p g y �4il g ation contained herein is true and complete. I certify under
pervalty of perjury under the laws of the State of California that the fo e i g is tr e aijd correct.
—_�• _ /___._- /
Executed on 02/29/2016 By � �� ,
DATE ��, %�/
MEASURE PROPONENT
��
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(Jan/2016}
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Staternent of Organization , � _ , a��
�Ecipient Committee � . � �
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I.D.NUMBER
David Fung for City Council 2016 1383579
• All cornmittees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Wells Fargo ( I
ADDRESS CITY STATE ZIP CODE
.. , , _
. . , .
4.Typ��of Co ` �r � � , � , �
rYt� r _, Cqrn�l�e the a�plf able secti�ns. . � .
,u �,
_ , _
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. .
• List tFue name of each controlling officeholder,candidate,or state measure proponent. If candidate or officeholder controlled,also list the elective office sought or held, and
distric:t number, if any,and the year of the election.
• List thie 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 HELO
(INCLUDE DISTRICT NUMBER 1F APPLICABLE) YEAR OF ELECTION PARTY
� Nonpartisan
Davidl Fung Cupertino City Council 2016
❑ Nonpartisan
� � � -� � Primarily formed to su��port or oppose specific candidates or measures in a single election. List below:
CANDIDATE�S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT N0.OR LETTER) CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
❑ ❑
FPPC Form 410(Jan/2016J
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov