410 Statement of Organization Recipient Committee – Initial Not Yet Qualified Stamped by SOSI 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 underpenalty of perjury pder the laws of the State
OFFICEHOLDER, CANDID ATE, OR STATE MEASURE PRO PONENT
Executed on
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (October/2023)
FPPC Advice: advice@)fp(x.ca.gov ($166/275-3772)
www.fppc.ca.zov
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Pagii2CO-MMITTEENAME '-' -'-'- -'-'- "'- -' -' -" -" - -'Barry Chang for Council 2024 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.
-MAME-OF i-INAN-CIAi-INST-lTu-TIO-N AN-D P"-ERSO-N'(S) AuTl'lORIZED'T6'0-B-T-AIN BAfflK RE-C-0-R-D-S--------------"""-'-'
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AREA CODE/PHONE
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CITY
ADDRESS OF FINANCIAL INSTITUTION
STATE ZIP CODEi Cupertino Ca 95014I11jAII!Wls n T ifi'i ?ij !E i5 !AN!!f!r5rMi I}nb
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List the name of each controliing offlceholder, candidate, or state measure proponent. If candidate or officeholder controlled,also list the elective office sought or held, and distrid number, if any, and the year of the election.
List the political party with which each offlcehotder 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 MEASllRE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF
EIECTION
PARTY
CHECK ONE
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"' Partisan "-71-iff 5ol'itiai!' pari'kielowj" ":
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Nonpartisan Partisan--"' -(list-pom'-cal'(iartybelow) -I
a * a - * a ' - Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(Sl NAME OR MEASURE(S) FULLTITLE llNCtUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASLIRE(S) JURISDICTIONIF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., ClTh OR COUNTY, AS APPLICABLEi CHECK ONE
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I SLIPPOFIT iI OP'POSE i
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- SIIPPORT I OPPOSE
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FPPC Form 410 (October/2023)
FPPC Advice: advtce@%pc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCT{ONS ON REVERSE
COMMITTEE NAME hge 3
I.a NUMBER
J ' *, - * '*!"
51a/7 Not formed to support or oppose specific candidates or measures in a single electton. Check only one box:
€ CITYCommittee [1 COUNTYCommittee [1 STATECommittee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
p9Q t ist additional SpOnSOrS On an attachment.
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
Date qualified
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 toGovernment 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 subjed to Electtons Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410 (Odober/2023)
FPPCAdvice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov