410 Statement of Organization Recipient Committee – Initial Not Yet QualifiedStatement of Organization
Recipient Committee
Statement Type ® Initial ❑ Amendment
Is Not yet qualified
or
Q Date qualified as committee I /
Date qualified as committee
x r': I.D. Number
or:�mat�on� I}� I
us (if applicable)
NAME OF COMMITTEE
Bharwad for Cupertino City Council
❑ Termination — See Fart
STREET ADDRESS(NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS {REQUiRED1 f FAX (0P710NA1)
COU NTY OF DOM€CILEJURISDICTION WHERE COMMITTEE 15 ACTIVE
Santa Clara County City of Cupertino
Attach additional information on appropriately labeled continuation sheets.
ave use all reasonable diligence in preparing this statement and to the best
penalty of perjury under the laws of the State of California that the
under.
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Bharwad for City Council 2018
• All committees'must list the financial institution where the campaign bank account is located.
-t OF FINANCIALINS7ITUT10N
-UJ t�IS To, 90,V1
ADDRESS
Page 2
I.D. NUMBER
BANKACCOUNT NUMBER
- -
STATE ZIP CODE
-r
• 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:' Stating "fro party preference" is acceptable:
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICFSOUGHTORFIELD YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION
CHECK ONE
Porth Bharwad Cupertino City Council 2038 Nonpartisan Partisan (list
Nonpartisan Partisan (list
0
CommitteePrimarily Formed Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(5) NAME OR MPASURE(5) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(5) OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. {INCLUDE D15TRICT NO., CITY OR COUNTY, AS APPLICABLE)
party
pa
CHECK ONE
SUPPORT OPPOSE
0 0
SUPPORT I . POSE
FPPC Form 410 (Feb ruary/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
MMITTEE NAME
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee ❑ Political Party/Central Committee
List additional sponsors on an attachment.
CITY
Small Contributor Committee
IN—I HT ,RUVY OR AFFILIATION OF SPONSOR
Page 3
I.D. NUMBER
STATE ZIP CODE AREA CODE/PHONE
-'.: ;, �:::::, t
5 Termina�ionl Re` wrementsr?
q Byslgning the veclficatTbn the treasurer assistant tasurerand/or cantlldate officeholder, -,or. ro onent cerli xha alhofthefollowl ,
;...w�I....._ck�:,, ....a,..P,;.>~"..:.a;
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• 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 (February/2018)
Gear Fuger Print , FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov