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410 Statement of Organization Recipient Committee – TerminationStatement of Organization Recipient Committee Date stamp , Statement Type For official Nye only ] Initial 0 Amendment 0 Termination —See Part 5 Filed Date: 0 Not yet qualified 07117/2023 09:58 or 0Date qualificationthreshold met Date qualification threshold met Date offermination AM 03/29/2023 1. Committee InformationLD. Number 14528942. Treasurer and Other Principal Officers �lapp�icanle� NAME OF COMMITTEE NAME OF TREASURER Govind Tatachari For Cupertino Council 2022 Balaji Seshachalam STREETADDRESS (NO P 0. BOX) 18820 Barnhart O BOX) CITY STATE ZIPCODE AREACODE,!PFONE 10219 Judy 95014 (408�771- ZIP CODE AREACODEJPHONE NAME OF ASSISTANT TREASURER, IF ANY Cupertino CA 95014 (408)206- ADDRESS IF DIFFERENT) STREETADDRESS (NO P,0. BOX; P.O. ADDRESS [REQUIRED)/FAX IOPTIONAL) CITY STATE ZIP CODE AREACODE,!PFONE govind4council@gmail.com DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICERiS) Santa Clara Cupertino GOVINDTATACHARI STREETADDRESS (NG P 0. BOX) PO Box CITY STATE ZIP CODE AREACODE;PHONE CUPERTINO CA 95014 (408)206- 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 of California that the foregoing is true and correct. Executed on 07/17/2023 By Balaji Seshachalam CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT 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 Organization CALIFORNIA410 Recipient Committee FORm INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER Govind Tatachari For Cupertino Council 2022 1452894 All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE Cupertino CA 95014 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. i List the political party with which each officeholder or candidate is affiliated or check "nonpartisan," Stating "No party preference" is acceptable i If this committee actsjointly 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 CAN DIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT(IN C JUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHEK ONE GOUINDTATACHARI CUPERTINO CITY COUNCIL City CITY OF Nonpartisan Partisan (list political partVbelow) 2022 D D CUPERTINO Govind Tatachari Nonpartisan Partisan list political party below) 0 D Primarily formed to support or oppose specific candidates or measures in a single election, List below, CANDIDATE(S) NAME OR MEASUREIS) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. CAN OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE SUPPORT OPPOSE D D SUPPORT OPPOSE D D FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca,gov (866/275.3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 3 COMIM 17EE NAME I . NUMBER Govind Tatachari For Cupertino Council 2022 1452894 Not formed to support or oppose specific candidates or measures in a single election, Check only one box: 0 CITYCommittee 0 COUNTYCommittee 0 STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY - List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRYGROUP OR AFFILIATION OF SPONSOR STREETADDRESS NO AND STREET CITY STATE ZIP CODE AREACODE,!PHONE D I . • This committee has ceased to receive contributions and make expenditures; This committee does not anticipate receiving contributions or making expenditures in the future; e 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. FW Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275.3772) www.fppc.ca.gov