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410 Statement of Organization Recipient Committee - Initial not yet qualified Statement of Organization - , Recipient Committee • - Statement Type ®Initial ❑ Amendment ❑ Termination—See Part 5 For Official use Only Not yet qualified © or List I.D.number: List I.D.number: MAR 6 3 2017 /--/ �---/ --�---/ CU ERTI�tO CITY CLERK Date qualified as committee Date qualified as committee Date of Termination (If applicable) 1S Carnm�ttee{nfolrrraa;�on� � � 2 ,' ;fr .. __ � ��� �s��,,,u . � � �2 �reasurera�d�Other PrJncipal Officers NAMEE OFFCOMMITTEE NAME OF TREASURER Better Cupertino Political Action Committee Xiaowen Wan STREET ADDRESS(NO P.O.BOX) STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE ( CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY MAILING ADDRESS(IF DIFFERENT) STREETADDRESS(NO P.O.BOX) FAX/E-MAILADDRESS CITY STATE ZIP CODE AREA CODE/PHONE COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S) Xiangchen Xu STREET ADDRESS(NO P.O.BOX) Attach additional information on appropriately labeled continuation sheets. CITY STATE ZIP CODE AREA CODE/PHONE 777 3 ".dexi canon w 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 that the foregoing;is true and correct. Executed on 31t2— /7-0f)! ) By DATE 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 � �CALIFORNIA RM 410 INSTRUCTIONS ON REVERSE Page 2 NeIPEMpertino Political Action Committee I.D.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 ADDRESS CITY STATE ZIP CODE 4 Type Of:Corn�rtlttee Complete theappllcablesecfions C.nlrolied Committee • 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 CAN DIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY ❑ Nonpartisan ❑ Nonpartisan I 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 SOUGHT OR HELD OR MEASURE(S)JURISDICTION (INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE SUPPORT OPPOSE SUPPORT OPPOSE FPPC Form 410(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Statement of Organization CALIFORNIA Recipient Committee _ INSTRUCTIONS ON REVERSE Page 3 `Mdr"Mpertino Political Action Committee I.D.NUMBER T/pC OfCam�xi�ttee (Corttnuetli , General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: d CITY Committee [] COUNTY Committee❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY Promote sensible growth, educate the public, empower our community, advocate transparency and accountability in local goverment. Sponsored CommitteeList additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE ❑�—✓� Date qualified 5 .Tel"mmat�an.Re ut Y C$171ent5.. • , B sl nIn the verlficatlon-th ,„B g etreasurer,asslstanttceasurerand�orcanddate officeholder,,or ro onen#cer#t,.that.all..oft e' ,ry This committee has ceased to receive contributions and make expenditures; condtt,ons haue;been met ....m�. ..,...�a ..., w . , • 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/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov