410 Statement of Organization Recipient Committee_Stamped by SOS 01-24-24•• ·--------------------------------------------
[43
Statement of Organization
Recipient Committee
Statement Type lfl1 1nltial
( 4 { 6 J? s JiECEIV!rfAND
0 Amendment ID Termination -See Part 5
0 Not yet qualified
or
0 Date qu a!ificallon threshold met I Date qua!tf1cation thre5hold met Dat e o/ termination
-1-1--I -1-1--I
1.0. Number w
r,f;:p,;l,r.;,b\:'J
N A!'.-1i. Of COMMH rH
Cupe r tino Vo i ce•
NAI.IE Of llUhSUil!R
Longl!.io
Slr.E!f :.oo~ES!,t,•,o P.O. SO:<)
~MA !t AVOk~~~ 01 HrEASu ,;;tR ilHQ1.;i M{O) L------,--,,~----------------1 STRH T AOOR l SS (NO P.O . li OX I
N,".1.EoF ~,1,1A1.i 1HA1.;Rrn.11 A>11
CIT Y S:TAlf ZIP (OD~ AREA(oo:,~11.Uh ~
I Cupertin o CA 95-il U ; I s1,H1 "-DOR1~~1i,,0 P.o ~ox!
FUlL MAILING AOO"il~ ii~ OIFHR(N 1)
_ .. ,;.,.;.: ..
1-------------------,-----------------------i HJ.All AOOAf.SJi 0 > A!,~!~TAUl H <t:ASU'R!R {R EQU'!RfO}
E•i\'IAll AODRiSS Of (OMMII fH t krn,U1REP! { fAA {O~l10>iAc)
M'-ll 01 "~"mPAc Off•CH(I J
C0Uhl1Y Cf OOMIOl l IUR1S01(11t.lr< WtiE~l COMM! I !HI> ACl !VE JOI\ \\"ilk•\"
I--____________ ..__ ___________________ --! S!i!;f f AOC~!H(l;O P.O. 80K!
Attach additional information on appropriately labeled continuation $heets .
fMAlL A.Ot)l\l 5:\ or Pijll>iCll',\L OH,tc~l~)lff!Q\il~!O)
(!JV
C 1.q iPr0.110
C/11
(111
Cup C'r linn
I have used all reasonable diligence i n preparing this state ment and to the best of my knowledge the information conta i ned herein •is true and complete.
penalty of perjury un;er t;;e ws of th e
1-t .i MOd:if.ii. (.;.,\O,C'A ~i. o~ ~1.:.1 £ ul-\iWH i!'Jol uPOM,.,r
Exe cut C?d an
UI( By ~-.U~J..f ~{ Cf (C.!li 1 l'0l.L\1~ Qi H~lHi..-'\.!.1 O ..,. (~l'\O~~\.:.H .C•ii( 'i T~H !'.~.A.>S..•r..t Jl""i.?-•-C.•ti !~!
Executed an
!.:~n. By-------------------------------------------"..-.:.i ·.,.l'. .. r,£ .:;r ~C.hl ?....; .. ~. ~~ ~:,.:::i ,,..,.j __: ~ ~.-:.'-!.:_,.'-,.:.;: ,.::;;. ::,,":.:.i 1. .\.1( :.!,,,.;.:i ¥1';::.,:~:_.~•t ,1.ol
~ l Al l
C,\
.LIP COllt
'J'JOl -1
AHE A (OlH./PtiO ~~E
l!A1f ZIP (UOf
AR EA COO<il't<ONE
!.TAT!: ZIPlOOE
CA 950!-I
AR l l , COOE /PtiONE
I certify under
A V 2 • I 7 (:-), '~) .-,
l.,,
FPPC Form 410 (October/2023)
FPPC Advice: ;!gvice@J_ppc.ca .9,ov (866/27S-3n21
y.'\'.!,'_'!'.l!,_{p_pf._.£~,.f!.Q.V
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
CALIFORNIA 41 Q
FORM
Page 2
I.D. NUMBER
• All committees must list the financial institution where the campaign bank account is located and the person(s) authorized to obtain bank records.
NAME OF FINANCIAL INSTITUTION AND PERSON(S) AUTHORIZED TO OBTAIN BANK RECORDS AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS OF FINANCIAL INSTITUTION CITY
Controlled Committee
• 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.
STATE
• 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.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF
ELECTION
PARTY
CHECK ONE
Nonpartisan Partisan
Nonpartisan Partisan
Primarily Formed Committee 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 "R ECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
ZIP CODE
(list political party below)
(list political party below)
CHECK ONE
SUPPORT OPPOSE
SUPPORT SUPPORT OPPOSE
FPPC Form 410 (October/2023)
FPPC Advice: advice@fppc.ca.gov {866/275-3772)
www.f~ov
Statement of Organization
Recipient Committee
INSTRUCTIO NS ON REVER SE
COMMITTEE N A ME
CALIFORNIA 41 Q
FORM
1.0 . N U M BER
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election . Check only one box:
Ill CITY Committee O COUNTY Committee O STATE Committee
PRO V IDE BRIEF DES CRIPTION OF ACT IV IT Y
Promote the City Council to make de ci sions based on surveys of Cup ertino re sidents and regist ere d vote rs.
Sponsored Committee List additional sponsors on an attachment.
N A ME OF SPONSOR I N DUSTRY GROUP O R AFF ILI ATION OF SPONSOR
STREET A DDRESS NO. A N D STR EET CIT Y STATE ZIP CODE AREA CODE/PHONE
Small Contributor Committee □--1--1--
• 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 campa ign 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 (Octobe r/2023)
FPPC Advice: a<:lvice@ f ppc.ca.gov (866/275-3772)
www.f~QI!