410 Statement of Organization Recipient Committee_Stamped by SOS 03-1-24Statement of Organization
Recipient Committee
2, Amendment
ID E C E [) V E
MAR - q 2024
Terminatiorh - See 5
C PERTINO CITY C RK
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Statement of Organization
Recipient Committee
INSTRtlCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D. NUMBER
All committees must list the financial insUtution where the campaign bank account is located and the person(s) authorized to obtain bank records.
NAME OF FINANCIAL INSTITUTION AND PERSONIS) AUTHOF112EDT0 0BTAIN BANK RECORDS AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS OF FINANCIAL INSTITUTION CITY STATE ZIP CODE
LiSt the name Of eaCh COntrOlling officeholder, candidate, or state measure proponent. If Candidate Or OffiCehOlder contmlled,
also list the elective office sought or held, and district number, if any, and the year of the election.
List the poliUcal party with which each offlceholder or candidate is affiliated or check "nonpartisan." Stating "No party preference" is acceptable.
& If thiS committee aCtS jOintl7 With another controlled committee+ liSt the name and identification number Of the Other controiled committee.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASkJRE PTIOPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(mciuoc DISTRICT wuxstti IF APPLICABLE!
YEAR OF
ELECTION
PARTY
CHECK ONE
Nonpartisan Partisan llist political paity below)
Nonpartisan Partisan (list political party below)
a * * 1( ; 7 7p II I - IJI iii i iiily rui med to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASUREIS) FULL TITLE (INCLUDE tlALlOT NO. OR LETTERI
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(uvciuoe DISTRICT NO., CITY OR COUNTY. AS APPLICABLE)CHECK ONE
Skfi?PORT OPPOSE
SLff'PCIRT OIIPOSE
FPK Form 410 ((ktober/2023)
FPPCAdvice:a ce . v(Q7S-3772}
www.%pc.ca.xov
SlaLeuX,nt of Organization
Recipient Committee
INSTRUCTIONS CIN REVERSE
Page 3
COMMIT?tE NAME 1.0. NUMBER
& - B - * a , * - . a /l (B % Nnt formed to support or oppose specific candidates or measures in a single election. Check only one box:
] CITY Committee [] COUNTY Committee [:] STATE Committee
F'ROVIDE BRIEF DESCRIPTION OF ACTMTY
Promote the City Council to tnake decisions based on surveys of Cupertino residents and registered voters.
h a i * List additional sponsors on an attachment.
STREET ADDRESS NO.ANDSTREET CITY STATE ZIP CODE AREACODE/PHONE
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Dabamfflm
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 at! 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 trarisactions.
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 baliot 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.
FPK Form41JOdober/2aQ3)
FPPC Advioe: IdViffMXK,#.Rff €866/275-3772}
www.fpoc.a.gov