410 Statement of Organization Recipient Committee - Termination 12-28-18 � n�
Statement of Organization a�m � • . ,
Recipient Committee • - � '
StatemelltType ❑�nitial ❑ Amendment � Termination—SeePar� �h�,! � ���� ForOfficialUseOnly
� Not yet qualified
or
o Date qualfication threshold met Date qualification threshold met Date oftermination �PER���Q ���' CL �K
_�� /_� � 28� 2018
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1. Cor��ittee lnfor,mafion.�� 1414447 �� �2 � Treasur�er and'Other,'Principa)Officers� � � '�
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NAMEOFCOMMITTEE NAME OF TREASURER
Cupertino Political Reforms PAC Xiangchen Xu
STREEf ADDRESS(NO P.O.BOX)
COUNTY OF DOMICILE lURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
Xiangchen Xu
3: Veri cation� ^�� ,�� � � '�, � , ,� ��
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I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contain�ed herein is�true and complete. I certify un�der
penalty of perjury under the laws of the State of California
PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLIING OFFICEHOLDER,CANDIDATE,ORSTATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(August/2018)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Orgarrization � • - � t
e
Recipient Committee • -
INSTRUCTIONS ON REVERSE
Page 2
COMMflTEE NAME I.D.NUMBER
Cupertino Political Reforms PAC 1414447
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIALINSTITUTION AREACODE/PHONE BANKACCOUNTNUMBER
ADDRESS CITY ` STATE ZIP CODE
� rui� i i � i i n 7 i 7 c i rr�.:
4:�rTYPe�Of COI'�Y�'II�QE COfl1pI8te tIl@"appllCat3IE SECLIOIIS ' i' i �Ir p ,. .,w,. �� ,� , , ���� .�� µ
: . _;� . ,. . ... , _. �,,,. . . �. .._:. ... .__ .:_. . ,. .��:�.�.....�.. ,�.,_�.�...,__.sA�,.��...�.�.. .�,.�.w�..��...�.. . �_._�_. ,� ,ry�. � _.. . w�.,.�. _ .._ . . _..__ _..
• 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"No 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 OFFICE SOUGHT OR HELD • YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IFAPPLICABLE) ELECTION CHECK ONE
Nonpartisan Partisan (Iist politiql party below)
❑ ❑
Nonpartisan Partisan (Iist political party below)
❑ ❑
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S)NAME OR MEASURE(5)FULLTITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(5)JURISDICTION
IFA RECALL,STATE"RECALL"IN FRONT OFTHE OFPICEHOLDER'S NAME. (WCLUDE DISTRICT NO.,CITY OR COUNTI;AS APPLICABLE) CHECKONE
SUPPORT OPPOSE
❑ ❑
SUPPORT OPPOSE
❑ ❑
FPPC Form 410(August/2018)
FPPC Advice:advice@fppc.ca.gov(866/2753772)
wwvv.fppc.ca.gov
Statement of Organiaation � • - � '
Recipient Committee • - ,
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D.NUMBER
Cupertino Political Reforms PAC 1414447
YP a . ; .
Y:T e'Of COI��I�P.P.�� � �COflL1flU2tI� i 'i i - i i � i i�ia�.�i� �. ,..a r p� �}�p ' '� 4 y �u i i I .. �
. . ,. . . . . . _ .�. _ ..a ^ ..,..�. !,i,Ui�...[,.1_F�_+�ix,wr:.va�. .�... ....���..�+,.,.�^�,-.....,,-..,.4.�� .,e..�.. ....�._ � ..i .e. __ 'u.�s,., l��� w e2..� ....Ilu,I.i.l�
- - - - " a in le election. Check onl one box:
Not formed to su ort or o ose s ecific candidates or measures m s
rr rr r � v
� CITY Cornmittee ❑ C�UIVYY Corrsmittee ❑ STATE Coea�smi4tee
PROVIDE BRIEF DESCRIPTION OFACTIVITY
- - List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AfFILIATION OF SPONSOR
STREETADDRESS NO.ANDSTREET CffY 5iATE 21PCODE AREACODE/PHONE
'- ❑ � �
Date qualfied
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S.;TE�1'1'TIITB'L7011'Re uirements.. Bysigningtheverficat�on,thetreasurer;,assistanttreasurer.and/orcandidate,officeholtler;orp'roponenicertifythatalLofthefollowingcondit�onshave�been"met ����' ,,"�:'�_.
.: . _. .... q :. � � ... � ;, � .,,__ti,.�w� , "�.��, ,. �_,���w..�. .�.,���. ..W .�,.. �. :� �._,M., . u.y�W�.,��.�_._u.,.=.��� _w .y�__�.�y_�W��..�. , ..x_...���.��u �.�L.� ,�
• 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 discBosing 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 Seciions 89511-89518,and are
subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410{August/2018)
FPPC Advice:advice@fppc.ca.gov(86fi/275-3772)
www fppc.ca.gov