410 Statement of Organization Recipient Committee - Termination Statement of Organization Date Stamp
Recipient Committee 1 ' • !
Statement Type 0 initial Q Amendment ® Termination—See Part 5 RECEIVEDFor Official Use Only
Notyet qualified cl Or List I.D.number: List I.D.number:
# # 9383579 �1A 6 201
03 10 2017 llPERTI O CITY CLERK
Date qualified as committee Date qualified as committee Date of Termination
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NAME OF COMMiTT£E
MENKINKOW
NAME OF TREASURER .
David Fung for City Council 2016 Kathy Jacques
STREET ADDRESS(NO P.O.SOX)
MAILING ADDRESS(iF DIFFERENT) STREET ADDRESS(NO P.C.SOX)
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE 15 ACTIVE NAME OF PRINCIPAL OFFICERS)
Santa Clara Cupertino, CA
STREET ADDRESS IND P.O.SOX)
Attach additional information on appropriately labeled continuation sheets. CITY STATE ZIP CODE AREACODE/PHONE
I have used a!i reasonable diligence in preparing this statementand to the best of my knowledge the information contained herein is#rue and complete. !certify under
penalty of perjury under the laws raf the State of if at a regoing is true and rnrrect,
Executed on �3/14/2017 BY
QATE
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 420(Jan/2016)
FPPC Advice:adviceaafppc.ca»gov(866/275-3772)
www.fppc.ca.gov