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410 Statement of Organization Recipient Committee – Amendment Stamped by SOS Statement of Qrganization DateStamp . i _ , � Recipient Committee ; : - Statement Type � �F��' y��� ' � _ ❑ Initial 0 Amendment ❑ Termination—See Part 5 �- � �•--�� °'�`' ��"' ` - `�orb�,��a�useo�i�� _. � � Q Not yet qualified In �e oiticc oT Ine S�c(U � ;�¢��'� � ` �i �': ; of the State of C����ornia ��; or 07 17 2018 = `' � � Date qualified as committee � � � � �1�!± (l� ��'�� ` ' � F�-�� � r ���� ; Date qualified as committee Date of termination t)€7 �t / / : ���-_—��_,�_�_ _ � 1. Committee Information �•D. Number 1407834 2. Treasurer and Other Frinc�pa)Office�-�— � �`�' � ������� � � (if aPplitable) _ NAME OF COMMITTEE NAME OF TREASURER Mahoney for Council -2�18 Carolyn Krizek-Mahoney STREET ADDRESS(NO P.O.BO%) COUNTY OF DOMICILE JUftISDICTION WHEftE COMMITTEE IS ACTIVE NAME OF PftINCIPAI OFFICER(5) Santa Clara anta Clara County Orrin Mahoney STREETADDRESS(NO P.O.BOX) � 3. Veri 'cation 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 MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTftOLLING OFFICEHOLDER,CANDIDATE,Oft STATE MEASURE PROPONENT FPPCForm 410(Februaryf2018j FPPC Advice:advice@fppc.ca.gov(866J275-3772) www.fppc.ca.gov Statement of Organization � • - � Recipient Committee • - � INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NpME I.D.NUMBEft Mahoney for Council-2018 1407834 • All committees must list the financial institution where the campaign bank account is located. NAME Of FINANCIAlINSTITUTION AREACODE/PHONE BANKACCOUNTNUMBER Wells Fargo AODRE55 4.T�/pe of Committee Complete the applicable sections. iiiiiii ' • 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 OFPICE SOUGHT OR HELD YEAR OF PARTY NAME Of CANDIDATE/OPRCEHOLDER/STATE MEASURE PROPONENT fINCLUDE DISTRICT NUMBER�f APPLICABLE) ELECTION CHECK�NE Nonpartisan Partisan (list political party belowj Orrin Mahoney Cupertino City Council 2018 � � Nonpartisan Partisan (list political party belowj � � Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLU�E BALLOT NO.OR LETTER� CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(Sj 1URISDICTION IF A RECAI.L,STATE"RECALL"IN FRONT OF THE OFFICEHOIDER'S NAME. {INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE $UPPORT OPPOSE ❑ ❑ SUPPORT OPPOSE ❑ ❑ FPPC Form 410(February/2Q18) FPPC Advice:advice@fppc.ca.gov(866(275-3772j www.fppc.ca.gov Stafement of Organization � • - � Recipient Committee • - � INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D.NUMBER Mahoney for Council-2018 1407834 4.Type af Committee {Continued) Not formed to support or oppose specific candidates ar measures in a single election. Check only one box: ❑ CITY Committee ❑ COUNTY Committee❑ STATE Committee❑ Political Party/Central Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY �• • �R � � , List additianal spo�sors on an attachment, NAME OF SPONSOft INDt15TRV GROUP OR AFFILIATION OF SPONSOR STftEET ADDRE55 NO.AN�$TREET CITY STATE ZIP CODE AftEA CODEJPHONE e ❑ �� Date qualified 5.Termination Requirements By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify that all of the fallowing 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. FPPCForm 410(February/2018j Clear Page Prinf FPPC Advice:advice@fppc.ca.gov{866/275-3772j www.fppc.ca.gov .