410 Statement of Organization Recipient Committee – Initial Not yet Qualified – Stamped by SOS .�
Statc;ment of Organization � ��j � �j � � DateStamp . � _ ,
Recipient committee �� FZ�CEIVED AI`!D FIL�� � - '
Statement Type `� �n the offi.e of the Secretary of State �- � Fo�or�;��aru5ea�� ` '�
0 Initial ❑ Amendment ❑ Termination—See Part Y �; ��� �� �
of I he State of Califomia �--`e;
Notyetqualified � or List I.D.number: List I.D.number:
�UN 2 0 2016 �
# � ,� ; JUL 1 l 20i6
J �
� / / / / /
Date qualified as committee Date qualified as committee Date of Termination y�1 -/� �
(Ifapplicable) '_l �'�'1,Ti'vo rITY l,� FR < .
1. Committee Information � , 2. Treasurer and Other PrincipaFOfficers �� °�' '�;., � �
NAMt OF COMMITTEE N�ME OF TRE�Sl1RFR
Jerry Liu for City Council 2016 Jennifer Fang
S7REET�DDRESS(NO P.O.BOX)
) CITV STATE ZIP CODE AREA CODE/PHONf
21837 Lomita Avenue
NAME OF ASSISTANI'TREASURER,IF ANY
Cupertino CA 95014 (408)996-1177 Nan Yu
MAILING ADDHESS(IF DIFFERENT)
CITV STATE Zlf'CODE I1REA CODE/PHONF.
2016@jerryliu.com
COUNTY OF DOMICILE lURISDICTION WHERE COMMITTEE ISACTIVE NAME OF PRINCIP�L OFFICFR(S)
Santa Clara ICupertino, CA
STREET ADDRESS(NO P.O.80%)
QTY STATE 21P CODE ARE�CODE/PHONE �
Attach additional information on appropriately labeled continuation sheets.
, ,
3. Verification .. ,. , � ° ;1 ,r. . �- r
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 ���'
� DA7E NA7URE OF C�OLLING OFFICEFIOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on gy .
DA7E SIGNATURE OF CONTROLLING OFFlCEHOLDER,CANDIDATf,OR S1AlE MEASURE PROPONENT
Executed on By
DATE SIGNATU2E OF CONTROLLING O(FICEIIOLDER,C�NDIDATE,OR S1ATE MEASURE PROPONENT
FPPC Form 410(Jan/T.016)
FPPC Advice:advice@fppc.ca.gov(866/275-?�772)
www.fppc.ca.gov
Sta`�ament of Organization
� � - .
Recipaent Committee � _ , �
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAMF .
Jerry Liu for City Council 2016 ID NUMBER
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION � AREA CODE/PHONE BANK ACCOUNT NUMBER
Wells Fargo Bank I( I ,
ADDRG55 CITY � .
STATE 7.IP CODE �
4. Type of Commlttee Complete the applicable sections. . ,; � , F° �
p�:lfi�i.illq�k0.•1u�n�i�14-� � ��� ' .
• 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 APPLICABLE) YEAR OF ELECTION . PARTY
� Nbnpartisan
Jerry Liu Cupertino City Council 2016
❑ Nonpartisan
��'�""������•�'�%���•r'+���������+t-�� Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(5)NAME OR MEASURE(S)FULL TITIE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE�S)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION ��
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) Cr�ECK oNe
� SUPPORT OPPOSE
I ���
I . J SUVP�ORI OPCJ
I
FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
_ � _ _
Stai�ernent of Organization ' • ' ' �
Recipient Committee �
• -
INSTRUCTIONS ON REVERSE �
Page 3
COMMITTEE NAME I.D.NUMB[R
Jerry Liu for City Council 2016
4.Type of Committee ',�cani;��ea� „ , ,:� �..,, .
, , , , :�� .:� �
- Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee❑ STATE Committee
PHOVIDE BRIEF DESCRIPTION OF ACTIVITY
���.,��,�.�•�.,.ks.�„�,���.s:+:� List additional sponsors on an attachment.
NAME OF SPONSOR IINDUSTRV GROUP OR AFFILIAI'ION OF SPONSOR
STREET ADDRESS NO.AND STREET CITV STATE ZIP CODE
I ❑
� �
Da[e quali(ied
5.Termination Requirements ey slgning the verification,the treasurer,assistant treasurer and/or candldate,officeholder,or proponent certify that all of the following conditibns 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.
FPPC Form 410(Jan/2,016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
_ � . — — — - ___.