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410 Statement of Organization Recipient Committee – Terminationstatement of Organization Recipient Committee Statement Type C3 Initial 0 Not yet qualified or 0 Date quaiffied. as committee 0 Amendment 0 Termination — See part a 07 3. � 2018 Date� almecommittee Date Df termination I.D. Number 1287471 (f applicable) NAMEOFCOMMITTEE CONCERNED CITIZENS OF CUPERTINO STREETADOR£SS(NO PO, BOX) CITY STATC zip CODE. AMCODEJPWONE MAILING ADDRES5 (1 DIFPEPENT) EMAIL AP DRESS IRcQU IRfiO) / FAX (OPTIONAL) Attach additional information on appropriately labeled continuation sheets. Far ofFlalal use 4ny JUL 3 3 2018 PERTINO CITY C Other Principal Offers Marolyn O. Chow STREET ADDRESS NO P,O. BOX) CITY STATE XIP CODE AREACODE/PKONE NA R1E OF ASSISTMT TREASURERS IF ANY STREET ADDRESS INO P.O. if0%) CITY STATE XIP CODE --- AREACODGrPWONE NAME OF PRiNCIPALCIFFICER(S) V BEET ADDR E5S (NO P.O. 60X) CITY STA7E ZIP CODE AREACODE/PEONE I have used all reasonable diligence in preparing information contained herein istrue and complete. i certify under Executed on DATC YSIGNA71iREDFCGN7DLLINGOFFICElIOLpER.CANbIpA7E,OR57ATBMEA5UREPROA60ENT Executm on By SIGNA7URE0P CONTROLLING OFFICEHOLDER, CANDIDATE, ORSTATE MEASURE PROPDN ENT DATL Executed on By DATE SIGNA7UREOFCC}NTROLLING OFFSCG NOLpER, CANbIDATE,ORSTATEMEASURE PROPONENT FppC Fprrn 410 (February/2018) FPPC Advice. adviC8@fPP0.Ca,80v (8661275.3772) www.fppc.ca.gov Statement of Organization Recipient Committee � INSTRUCTIONS ON REVERSE I Panda COMMITTEE NAME CONCERNED CITIZENS OF CUPERTINO 1x$7471 e All committees must list the financial institution where the carnpaign bank account is located, NAME OF FINANCIAL INSTITIJ Citibank, NA #120 AWRESS AREA CODE/FHONE STATE ZIP C. jf0Ef. 1 C��1 tit l=q. Corhplete the;agp icable sections. m 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. * Listthe political partywith which each officeholder or candidate is affiliated or check "nonpartisan," Stating "No party preference" is acceptable. m if this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. ELECTIVEOFFICESOUGHTORHELD YEAKOF NAMEOFCANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT fINCUJDEDISTRICT NUMBER IFAPPLICABLE) ELECTION F -1 liN3tt' . - Primarily formed to support or oppose specific candidates or Treasures in a single election. List below; PARTY Pam CANDIDATES) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO, DR LETTER) CAN DIDATEW OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION Ir A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME, (INCLUDE DISTRICT NO -,CITY OR COUNTY, AS APPUtABLC) CHECK ONE sUi,P�ORT OPPOSE -r-I El FFPC Form 410(February]28181 FPPC Advice, advice@fppc.ca.gov (866/275.3772) www.fppt.ce.gov statement of Organization on Recipient Committee INSTRUCTIONS ON REVERSs P-0-'3' C©NCER.NED CITIZENS OF CVPERTIN4 11287471 mom °,'>IYp€ „of COMMittee .icontinuedf ® Not formed to support or oppose specific candidates or measures in a single election. Check only one box: 0 CITy Committee [] COUNTY Committee 0 STATE Committee ❑ political Party/Central Committee maul DE iaRleP nEscRlPriaN at: AGM1'tVf7Y Farmed to support or oppose issues regarding the City of Cupertino. „ . ! List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFI LIATIO N OF SPONSOR CfTY STATE ZIPCOGI ARERCO; FjPldaNE STRCETAOORM NO, ANDSTAR7 IN + + ® IYaEa 4uallflcd 1 0-9-1 S.. `� r€ 11t1 jpl ;� a Wrement 6y signing thcvsrifidratlan, the:tre�rsurer, aSSIA;nt treasarerand/or eandldatc, officei�0ww, or:proponent car* thbti all Of+he;£oilawln canditic�ns lrava been i� e�; o This committee has ceased to receive contributions and make expenditures; W This committee does not anticipate receiving contributions or making expenditures' in the future; m This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; a This committee has no surplus funds; and o This committee has filed ail campaign statements required by the Political Reform Act disclosing all reportable transactions. -- There art 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 maybe used for political, legislative or governmental purposes under Government Cade Sections 89511- 89519, and are subject to Elections Code Section 18580 and FPPC Regulation 18521.5. FPpPC Form 410 (February/2018) =parftge� P�PPCAdvice: atflvice@fppc.ca.gov (865/275-3772) wvsw.fppc.ea.gor+