410 Amendment
Type or print In Ink
Statement of Organization
Recipient Committee
2005
1
1
AUG
o
o Termination - See Part 5
List 1.0. number
00 Amendment
List 1.0. number:
o
Not yet qualified 0
Initial
Statement Type
PERTINO CITY Cl
C
#
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Date of Tennination
1278545
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Date qualiUed as committee
(If applicable)
#
or
---1---1_
Date qualified as committee
2. Treasurer and Other Principal Officers
Committee Information
NAME OF COMMITTEE
Committee to Elect
1
AREA COOEJPHONE
408/750-4714
ZIP CODE
95014
STATE
Ca
NAME OF TREASURER
Claudette Miller
STREET ADDRESS
20348 Clay Street
CITY
Cupertino
NAME OF ASSISTANT TREASURER, IF ANY
AREA CODElPHONE
408/7504714
ZIP CODE
95014
STATE
Ca
Marty Miller
STREET ADDRESS (NO P.O. BOX)
20348 Clay Street
CITY
Cupertino
MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS
AREA CODEIPHONE
ZIP CODE
STATE
CITY
E-MAIL ADDRESS
OPTIONAl: FAX
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
COUNTY OF DOMICILE
AREA CODElPHONE
ZIP CODE
STATE
MAILING ADDRESS
CITY
Santa Clara
certify under penalty of
to the best of my knowledge the information contained herein is true and complete.
true and correct. -.-,
By
By
Attach additional information on appropriately labeled continuation sheets.
Verification
I have used all reasonable diligence in preparing this statement and
pe~ury under the laws of the State of California that the foregoing is
/,
3.
!:>~
"b/<tl ~.
ÕÃTE
Executed on
on
Executed
Executed on
CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE Of CONTROlLING OffiCEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Fonn 410 (JanulryI05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)
SIGNATURE Of CONTROlUNG OfFICEHOLDER,
By
By
DATE
DATE
Executed on
.D. NUMBER
1278545
list the elective office sought or held, and
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Committee to Elect Marty Miller
4. Type of Committee Complete the applicable sections.
controlled, also
candidate or officeholder
If
list the name of each controlling officeholder, candidate, or state measure proponent
district number. if any. and the year of the election.
List the political
·
party with which each officeholder or candidate is affiliated or check "non-partisan.
f this committee acts jointly with another controlled committee,
·
·
controlled committee
list the name and identification number of the other
NAME OF CANDIDATElOFFICEHOLDE
committees only)
I I
Cupertino National Bank
ADDRESS
20230 Stevens Creek Blvd
Idate election
AREA COOElPHONE J BANK ACCOUNT NUMBER
408/996-1144 or 800/BANKCNB 1001122437 _
CITY STATE ZIP CODE
Cupertino Ca 95014-1350
NAME OF FINANCIAL INSTITUTION
·
below'
Primarily fonned to support or oppose specific candidates or measures in a single election. list
CANDIDATE(S) NAME OR MEASURE(S) FULL TITI
"..----- -.-....-. .'-., -.. . -.. ---... .,. -... . -.-. ---, .....n<:\A\vlu:;
1 ¡-I-
SUPPORT OPPOSE
FPPC Form 410 (JlnulryI05)
FPPC Toll-Free Helpline: 8661ASK-FPPC (8861275-3772)
Statement of Organization
Recipient Committee
.0. NUMBER
1278545
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Committee to Elect Marty Miller
Check only one box:
(Continued)
Not formed to support or oppose specific candidates or measures in a single election.
00 CITY Committee 0 COUNTY Committee 0 STATE Committee
4. Type of Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
campaign of Marty Miller to the Cupertino City Counci
to raise funds & make expenditures to suport the Nov. 2005 election
additional sponsors on an attachment.
lis
NDUSTRY GROUP OR AFFILIATION OF SPONSOR
f the committee qualified as a
ZIP CODE
committee.
STATE
Check box and provide the date this committee qualified as a small contributor
small contributor committee on January 1,2001, enter 1/1/01.
CITY
NO. AND STREET
o '---1_
Date qualified
STREET ADDRESS
or proponent certify that all of the following conditions have been met
the treasurer, assistant treasurer and/or candtdate, officeholder,
By signing the verification,
5. Termination Requirements
This committee has ceased to receive contributions and make expenditures;
·
making expenditures in the future;
to discharge all loans received, and other obligations;
This committee does not anticipate receiving contributions or
debts,
committee has eliminated or has no intention or ability
This
This committee has no surplus funds; and
This committee has filed all
·
Refer to
FPPC Fonn 410 (JlnuaryI05)
FPPC Totl-Free Helpline: 8661ASK-FPPC (8661275-3772)
transactions.
There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates.
Government Code Section 89519.
reportable
campaign statements required by the Political Reform Act disclosing al
·