410 Statement of Organization Recipient Committee - Amendment Statement of Organization , °ate s`a"'p , • . .
L� C� (� 111� � �� �
Recipient Committee ' �D � � • ' ,
Statement Type # ; g For Official Use Only
❑Initial � Amendment ❑ Termination-See Part 5 <
d �
Notyetqualified ❑ Of List I.D.number. List I.D.number: � �
JUN 2 ,; 2016 ' '
# 1383579 # ' � '
i `I
06 21 2016 � W r, � �
� � � � � � � Cl9PF�r�.i�s��;� u�TY G��R�
Date qualified as committee Date qualified as committee Date of Termination c ,�
(If applicable)
1. Committee Information 2. Treasurer and Ot�er Principal Officers
NAME OF COMMITTEE NAME OF TREASURER
David Fung for City Council 2016 Kathy Jacques .
STREET ADDRE55(NO P.O.BOX)
,
) CITY STATE ZIP CODE AREA CODE/PHONE
7539 Barnhart Place (
CITY STATE ZIP CODE NF,ME OF ASSISTANT TREASURER,IF ANY
Cupertino CA 95014 (408)840-3864 ,
STREET ADDRESS(NO P.O.BOX)
P.O. Box 281, Cupertino, CA 95015 ,
CITY STATE ZIPCODE AREACODE/PHONE
dfung@symian.com ,
COUNTY OF DOMICILE lURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
Santa Clara ICupertino, CA ,
STREET ADDRESS(NO P.O.BOX)
CITV STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
3. Verit�cat�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
�
Executed on By
DATE ✓�I NATU C/F CO T OLLING OFFICEHOLDER,CANDIDATE,OR STATE 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
Statement of Organization , � . ,
Recipient Committee � . � �
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I.D.NUMBER
David Fung for City Council 2016 1383579
• All committees must list the financial institution where the campaign bank account is located.
NAME OF fINANCIALINSTITUTION AREACODE/PHONE BANKACCOUNTNUMBER �
Wells Fargo ( I
ADDRE55 CITY STATE ZIPCODE
4.Type Of COmmlttee Complete the applicable sections. '
. . .
• 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 OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABIE) YEAR OF ELECTION PARTY
� Nonpartisan
David Fung Cupertino City Council 2016
❑ Nonpartisan
� � •• � Primarily formed to support or oppose specific candidates or measures in a single efection. List below:
CANDIDATE(S)NAME OR MEASURE�S)FULL TITLE(INCLUDE BALLOT N0.OR LETTER) CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(5)JURISDICTION
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
� �
SUPPORT OPPOSE
❑ ❑
FPPC Form 410(1an/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov