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410 Statement of Organization Recipient Committee – Initial Not Yet QualifiedStatement of Organization Date Stamp CALIFORNIA Recipient Committee FORM Statement Type is Initia! El Amendment ❑Termination —See Part 5 For O Official Use Only 0 Not yet qualified or ❑ Date qualification threshold met Date qualification threshold met Date of termination I.D. Number NAME Of COMMITTEE NAME OF TREASURER 2022 Chioorit pQY1110 LIA1JJ Nicole Woon I STREET ADDRESS (NO P.O. RO%) 20380 ADDRESS(NO P.O. SOX) CITY STATE ZIP CODE AREA CODE/PHONE 10175 CA 95014 408- STATE ZIP CODE AREACODVPHONE NAME OF ASSISTANT TREASURER, IF ANY Cupertino CA 95014 408- MAILING ADDRESS (IF DIFFERENT) STREET ADORESS (NO P.O. SOX) E-MAIL ADDRESS(REQUIRm) I FAX(orTnowm) CITY STATE ZIPCODE AREA CODE/PHONE Liang4CupertinoCoundl® OF DOMICILE JURISDICTION WHERE COMMUTES IS ACTIVE NAME OF PRINCIPAL OFFICER($) Santa Clara Cupertino Chao, Liangfang STREET ADDRESS (NO P.O. BOX) 10175 additional Information on appropriately labeled continuation sheets. CITY STATE ZIP CODE AREACODE/PHONE Cupertino CA 95014 408- have used all reasonable diligence in preparing this statement and to the best of my knowteage the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of correct. won ,/)71 �z2- 8Y DATE SIGNATURE CANDIDATE, OR STATE MEASURE PROPONENT Executed On DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on by DATE SIGNATURE Of CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (August/2018) FPPC Advice: (866/275-3772) Statement of Organization CALIFORNIA ' i Recipient Committee FORM INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME t.D, NUMBER Liang Chao for Cupertino City Council 2022 • All committees must list the financial Institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREACCOE/PHONE BANK ACCOUNT NUMBER ADDRESS CITY STATE Zip CODE • 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 parry preference" is acceptable • If this committee acts jointly 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 CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE Nonpartisan Partisan (list political parry below) Chao, Liangfang Cupertino City Council 2022 ✓ Nonpartisan Partisan (list political party below) • 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) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION IF A RECALL, STATE `RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE SUPPORT OPPOSE SUPPORT OPPOSE FPPC Form 410 (August/2018) FPPC Advice: (866/275-3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Liang Chao for Cupertino City Council 2022 General Purpose Committee -]� Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee PROVIDE BNEF DESCRPTION OFACTDATY List additional sponsors on an attachment. NAME OF SPONSOR STREETADORESS NO. AND STREET CITY DUSTRY GROUP OR AFFILIATION OF SPONSOR lull STATE ZIP CODE AREACODE/PHONE Small Contributor Committee❑ r� --!Date Gu•IHW • 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 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 (August/2018) FPPC Advice: (866/275-3772)