410 Statement of Organization Recipient Committee - Amendment Stamped by SOSStatement of Organization
Recipient Committee
Courtesy Copy
~~-----------,-.----------------------... Statement Type O Initial Ill Amendment 0 Tennination -See Pa
0 Not yet qualified
or
0 Date qualification threshold met Date qualification threshold met ·Date of termination
_o_s_-1, 06 , 2022
Sheila Mohan For Cupertino City Council 2022 Ram P Mohan
STREET ADDRESS (NO P.O . BOX)
Date Stamp
Ct!IVED AND n; olicie of the secretal'Y ~
of the State of Cellfomia
SEP28 2022
STREET ADDRESS (NO P.O . BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Cupertino Ca 95014
FULL MAILl"G ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL)
COUNTY OF DOMIO LE
Santa Clara !JURISDICTION WHERE COMMITTEE IS ACTIVE
Cupertino
Attach additional information on appropriately labeled continuation sheets.
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
STATE
Ca
STATE
STATE
OCT l 9 2022
PJE!'.li~AR Cf YOTE:P,S
COJITTi Cf SMT A D:.AP.A,
ZIP CODE AREA CODE/PHONE
95014
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. I certify under
penalty of perju under the laws of the State of
OR STATE MEASURE PROPONENT
Executed on
DATE
Executed on
DATE
By------------------------------------------SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
sv ________ _,....,,,,,.=---,.,=~,----------=,,.........,.,,,~~---=-=--------
s1G111AruRE OF CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
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www.fooc.ca.go\/