410 Statement of Organization Recipient Committee - Termination stamped by SOS Statement of Organization Date Stamp .
Recipient Committee A
Statement Type El Initial RECEIVED ANDIF" PD1
❑ Amendment ® Termination—See Part 5 in th8 sfiGB Qf€K 6 w�'Gretc3r�f DI ist6 + j c' t �llffic.�us�onl�jv
Notyet qualified ❑ or List I.D.number: List I.D.number: f the std of Califomia € I I
11 31
1390787 i I
01 /31 /2017
Date qualified as committee Date qualified as committee Date of Termination �0 "9. If Ir a61e `
1;�Committee Informafion -
NAMEOFCOMMITTEE NAME OF TREASURER -
Kris Wang for City Council 2016 Angela Tsai
STREET ADDRESS(NO P.O-BOX)
MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O-BOX)
FAX/E-MAIL ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS(NO P.O.BOX)
Attach additional information on appropriately labeled continuation sheets. CITY STATE ZIP CODE AREACODE/PHONE
1 Verificat>lon � �� � .P�
�.. ,...., ...: �_ � "�""�' sa� �����7'°n' .`��.�;t,., "� � 4�.- '3°�M1�t�r.."�er_'"'r-`.'�-? �"' .�sa. aFi?-� _ �"�"�"•- � - _r r �,
1 have used all reasonable diligence in preparing this statement and to the best of my knowledge the information containedherein is true and complete. I certify under
penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on 01/31/2017 By
DATE
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 CALIFORNIA
Recipient Committee _ 410
INSTRUCTIONS ON REVERSE
Page 2
risang for City Council 2016 I.D.NUMBER
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE
ADDRESS CITY STATE ZIP CODE
�} ._..�. ...._s'..G'+r •: �r-..+.1, �,i, v.3�'�.:.;�'a y-4'_.`y."�'+ - - ��-,➢w .. ,at.. 'xt: _
• 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 CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
® Nonpartisan
Kris Wang Cupertino City Council 2016
❑ Nonpartisan
Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S)NAME OR MEASURE(S)FULLTITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(S)OFFICE SOUGHTOR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICT NO-,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
El F-1
SUPPORT OPPOSE
FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov