410 Statement of Organization Recipient Committee - Initial Not Yet Qualified Staternent of Organization D � � �e�"� � . • - .
Recipient Committee � , '
. �
Statement Type ��nitial ❑ Amendment ❑ Termination—See Part 5 For off�ciat use only
Not yet qualified � or List I.D.number: List I.D,number: ,�U N � 6 2016
# #
� � � � � � CU �ERTINO CfTY CLER�
Date qualified as committee oate qualified as committee Date of Termination
(If applicable)
1.. Gommittee lnformatio . . . .. .... .. .. .... . al Offi. ._.... ..._... _ .. .. .. .----.
n . . . ._ . 2. Treasurer and Other Prirrcip � .
' cers
NAME OF COMMITTEE NAME OF TREASURER
Jerry Liu for City Council 2016 Jennifer Fanq
21837 Lomita Avenue
STftEETADORE55(NOP.O.BOX) CITY STATE ZIPCODE AREACODE/PHONE
21837 Lomita Avenue Cupertino CA 95014 (408)996-1177
CITY STATE 21P CODE NAME OF ASSISTANT TREASURER,IF ANY
Cupertino CA 95014 (408)996-1177 Nan Yu
MAILING ADDftE55(IF DIFFERENT) � ,
1935 Cappelletti Court ,
F�X/E-MAILADDRE55
COUNTY OF DOMICILE lURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPALOFFICER(5)
Santa Clara ICupertino, CA
. STREET ADDRE55(NO P.O.BOXI
CITY STATE ZIPCODE AREACODE/PHONE
Attach additiona/information on appropriately labeled continuation sheets.
3. V�e vlfiUa tlon reasonable diligence in preparing this
`'�"_�;�' �--�,>/ ,� .
DATE SIGNATGRE OF CONTROLLlNCrOFFICEHOL�ER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLIING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By ,
DATE 516NATURE OF CONTROILING 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 Gommittee • �
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D.NUMBER
Jerry Liu for City Council 2016
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIALINSTITUTION AREACDOE/PHONE
CITY STATE ZIPCODE
10260 South De Anza Blvd Cupertino CA 95014
..... . ... .. .._.. . . _.... . . . .
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.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANOIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
� Nonpartisan
Jerry Liu Cupertino City Council 2016 ,
❑ Nonpartisan
. • •• • Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S)NAME OR MEASURE(5)FULL TITLE(INCLUDE BALLOT NO.OR LETTER) �ANDIDATE(S)OFFICE SOUGHT ORHELD OR MEASURE(5)JURISDICTION
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) cHECK oNE
SUPPORT OPPOSE
SUPPOflT OPPOSE
. ,,.,,... ,.... _. ....,.,..�........ ....... ��.....,.,.,.,., , ...,,., � ,�...,..,..,�. ,,..�,.. �...,.. ..�.,..,.,....,..,,, �� .,.���, ..,���..�„�.��
FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/2753772)
www.fppc.ca.gov
Statement of Organizat6on ' • " ' d �
Recipient Cornmi�tee • �
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME � I.D.NUMBER
Jerry Liu for City Council 2016
. . .. ... .... . . . . . .. ... .... . . .. .. .. .. . .. .. . . ... . ...., .._ _. ... . . ... . . � . . .._ . ......,.. _.. . . ..........�
4.Type of Committee (Continued) .
- • ' �� • • Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Commi�tee ❑ COUNTY Committee❑ STATE Commi4tee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY .
�:�a�...�1.�.+.ks.j�,�.,�y:.:l:� List additional sponsors on an attachment.
NAME OF SPONSOR IINDUSTRYGROUP OR AFFILIATION OF SPONSOR
STREETADDRESS NO.ANDSTREET CITY STATE ZIPCODE
� � � ❑
� �
Date qualified
5.Ter �nat�on Re uirements sv s� nin the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify that all of the following conditions ha
m• q g g ve 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
o 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/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov