410 Statement of Organization Recipient Committee – Initial Not Yet Qualifiedstatement of Organization
Zecipient Committe
statement Type nitE I ❑ Amendment
of yet qualified
or
O Date qualified as committee ---/ /
Date qualified as committee
.. Committee information I.D. Number
(if applicable)
NAME OF COMMITTEE
61=� �1
FAX
COUNTY OF DOM CILf J" JURISDICTION W HER@ MMIFfEE IS ACTIVE
Attach additional information on appropriately labeled continuation sheets.
Date Stamp
MAR 2 1 2018
❑ Termination — See Part 5
UPERTINO CITY
-( —/
Date of termination
2, Treasurer and Other Principal Officers
OF TREASURER
-� L s�
CITY
For Official Use Only
11
pay,—moi
STREET ADDRESS (NO P.Q. BOX)
CITY STATE ZIP CODE AREACODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
I. rification
I have used all reasonable diligence in preparing this
PROPONENT
Executed ongy
DATE SIGNATURMraunncn rAran,nare ..e r.....,....._-_____..__._
Executed on 9y
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (February/2o1$)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
'statement of Organization
Zecipient Committee
4STRUCTIONS ON REVERSE
OMMITTEE NAME
Ali committees must list the financial institution where the campaign bank account is located.
vie ills,
ADDRESrrS
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:' I 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.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY
` p (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECKONE
ojr NanparNsxPartisan (list political party
L I ❑
Primorily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO, OR LETTER) CANDIDATES) 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)
IN]
FPPC Form 430 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866%275-3772)
www.fppc.ca.gov
'tatement of Organization
teciplent Committee
0TRUCTIONS ON REVERSE
OMMITTEE NAME
E. Type ofmmlttee (Cantimed)
General u Purpose CommitteeNot 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
tOVIDE BRIEF DESCRIPTION OF ACTIVITY
iii
• • • . • , List additional sponsors on an attachment.
Ah—
TR£ET
CITY
GROUP OR AFFILIATION OF SPONSOR
Page 3
ZIP CODE AREA
SM011 Contributor Committee
Date qualified
i. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the failowing 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 maybe 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.
Clear Page Print FPPC Form 414 (February/2018)
FPPC Advice: advice@fppc.ca.gov (856/275.3772)
www.fppc.ca.gov