410 Statement of Organization Recipient Committee - Initial Not Yet Qualified Stamped by SOSVJ -Statement of Organization Date Stamp Recipient Committee CEIVED ANO FILED Statement Type Ill Initial D Amendment D Termination -See Pa"'r?i iii t:ifflel:l of th@ secretary of State llflf f:3 74 0 Not yet qualified or 0 Date qualification threshold met I Date qualification threshold met ---./---,1-----.1--,--..------.__ ___________ _._ __ I.D. Number (if applicable) NAME OF COMMITTEE Sheila Mohan For Cupertino City Council 2022 STREET ADDRESS (NO P.O. BOX) 10960 Santa Teresa Drive CITY Cupertino FULL MAILING ADDRESS (IF DIFFERENT) E-MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL) sheilamohan1616@gmail.com COUNTY OF DOMICILE Santa Clara STATE ZIP CODE CA 95014 JURISDICTION WHERE COMMITTEE IS ACTIVE Cupertino AREA CODE/PHONE 408-839-5405 Attach additional information on appropriately labeled continuation sheets. i;,f th!,! Stat§ gt Cal!tornig Date of termination MAY aa 2022 NAME OF TREASURER Ram PMohan ·STREET ADDRESS (NO P.O. BOX) 10960 Santa Teresa Drive CITY Cupertino NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY .,,, ~~,.• .. ,r; .. , ,,.,,.1-.,.,. STATE CA STATE STATE ZIP CODE AREA CODE/PHONE 95014 408-839-7575 ZIP CODE AREA CODE/PHONE ZIP CODE AREA CODE/PHONE 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. penalty of perjury ' .. nd. ~1he laws of the State of Calif~ the foregoi~ !s true and correct. Executed on 5i l7LLo ft-By ___ __,.!!:(/_ v_ ~--...:....;;__.l:::il~M--:..::.... _______________________ _ Executed on ✓ { I 1 l l ;,-v 0\-CI') I DATE Executed on DATE Executed on DATE By By By (} j .1 SIGNATURE OF TREASURER OR ASSISTANT TREASURER ---<V~~ . SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT 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
I Statement of Organization Recipient Committee CALIFORNIA 41 Q FORM INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER Sheila Mohan For Cupertino City Council 2022 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION Wells Fargo Bartk ADDRESS 10260 S De Anza Blvd Controlled Committee AREA CODE/PHONE 408-863-6100 CITY Cupertino BANK ACCOUNT NUMBER 6221054247 STATE ZIP CODE 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. • 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 Sheila Mohan Cupertino City Council 2022 Nonpartisan ./ Nonpartisan 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 "RECALL" 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) Partisan Partisan (list political party below) (list political party below) CHECK ONE SUPPORT OPPOSE SUPPORT SUPPORT OPPOSE FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.f~ov