410 Statement of Organization Recipient Committee – Initial Not Yet QualifiedStatement of Organization
Recipient Committee
Statement Type El Initial
Q Not yet qualified
or
O Date qualified as committee
❑ Amendment ❑ Termination — See Part 5
Date qualified as committee Date of termination
1. Committee InformationI I.D. Numbe
(if applicable)
NAME OF COMMITTEE
Cupertino Residents for Local Ethical Government
STREET ADDRESS (NO P.D. BOX)
CITY STATE ZIP CODE AREACODE/PHONE
MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Santa Clara County Cupertino
Attach additional information on appropriately labeled continuation sheets.
For Official Use Only
C- P 2 i1
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Gary E. Jones
STREET ADDRE55 (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF A5515TANT TREASURER, IF ANY
Nancy L Warren
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
Oscar Hur
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
3. Veri 'cation
I have used all reasonable diligence in
Executed on
DATE
By
MR
PROPONENT
Executed on By
DATE 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
Cupertino Residents for Local Ethical Government
I.D. NUMBER
2a. Additional Officers/ Assistant Treasurers
NAME
NAME
Michael Malik
MAILING ADDRESS
MAILING ADDRESS
CITY STATE ZIP CODE
AREA CODE/PHONE
CITY
STATE
ZIP CODE
AREA CQDE/PHQNE
NAME
NAME
MAILING ADDRESS
MAILING ADDRESS
CITY STATE ZIP CODE
AREA CODE/PHONE
CITY
STATE
ZIP CODE
AREA CODE/PHONE
NAME
NAME
MAILING ADDRESS
MAILING ADDRESS
CITY STATE ZIP CODE
AREA CODE/PHONE
CITY
STATE
ZIP CODE
AREA CODE/PHONE
NAME
NAME
MAILING ADDRESS
MAILING ADDRESS
CITY STATE ZIP CODE
AREA CODE/PHONE
CITY
STATE
ZIP CODE
AREA CODE/PHONE
FPPC Form 410(February/2018)
www.netfile.com FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Paget page 3 of 4
COMMITTEE NAME I.D. NUMBER
Cupertino Residents for Local Ethical Government
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION ( AREACODE/PHONE I BANK ACCOUNT NUMBER
Bank of San Francisco (
ADDRESS CITY STATE ZIP CODE
San Francisco CA 94105
4. Type of Committee Complete the applicable sections.
• 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 IF APPLICABLE) ELECTION CHECK ONE
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
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT I OPPOSE
OPPOSE
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
B7•Pilul��liq
Page 3 page 4 of 4
Cupertino Residents for Local Ethical Government
4. Type of Committee (Continued)
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
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
To support ethical and oppose unethical candidates for office in the City of Cupertino
List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
i a ❑
Date qualified
S. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the following conditions have been met:
• 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)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov