410 Statement of Organization Recipient Committee – AmendmentStatement of Organization
Recipient Committee
Statement Type ❑ Initial
Q Not yet qualified
or
Q Date qualified as committee
® Amendment
09 / 02 / 2014
Date q'I alified as committee
I.D. Number
(if applicable) 1370390
NAME OF COMMITTEE
SAVITA VAIDHYANATHAN FOR CUPERTINO CITY COUNCIL 2018
❑ Termination — See Part 5
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL)
LOUNTY OF DOMICILE
Santa Clara
WHERE COMMITTEE IS ACTIVE
Cupertino
Attach additional information on appropriately labeled 'continuation sheets.
I have used all reasonable diligence in preparing this statement and to
penalty of perjury uner the laws of the State of California that the for
Executed on 4"--k !,�f t � By y
Executed on t By
DATE
Executed on
DATE
Executed on
DATE
Date of termination
Date Stamp
C E WLlq-
R1 6 2018
For Official Use Only
NAME OF TREASURER
RAMAMURTHY VAIDHYANATHAN
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREACODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
CAROLYN KRIZEK-MAHONEY
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREACODE/PHONE
're best of my knowledge the information co
going igpe and correct.
MEASURE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
n is true and complete. I certify under
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 Page 2
SAVITA VAIDHYANATHAN FOR CUPERTINO CITY COUNCIL 2018 I.D. NUM BER
•
All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
AREA CODE/PHONE BANK ACCOUNT NUMBER
WELLS FARGO BANK (
ADDRESS
CITY
STATE ZIP CODE
•List the name of each controlling officeholder, candidatle 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 c 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 othero
c ntrolled committee.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD YEAR OF
(INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION PARTY
CHECK ONE
SAVITA VAIDHYANATHAN Nonpartisan Partisan
CUPERTINO CITY COUNCIL 2018 EZI
Nonpartisan Partisan
E] ❑
ff
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
IF A RECALL, STATE "RECALL" IN FRONTOF THE OFFICEHOLDER'S NAME. IF OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
pa rty
pa rty
CHECK ONE
SUPPORT OPPOSE
❑ ❑
SUPPORT
T OPPOS,
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Not formed to support* 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
List additional sponsors on an attachment.
NAME OF SPONSOR
GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.ANDSTn FFT
Small Contributor Committee
STATE ZIP CODE AREA CODE/PHONE
• This committee has ceased to receive contributionsjand make expenditures;
• This committee does not anticipate receiving contrilputions 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 disclosingall reportable p 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
subject to Elections Code Section 18680 and FPPC Regulation 18521.5. Sections 89511 - 89518, and are
=r�p
PrlCleaint
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov