410 Initial
Statement of Organization STATEMENT OF ORGANIZATION
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Statement Type IXIlnitlal 0 Amendment 0 Termination - See Part 5
Not yet qualified III or list I.D. number: list I.D. number: AUG 1 1 2005
# #
----1 1 ----1 1 ----1 1 PERTINO CITY CL RK
Date qualified as committee Date qualified as committee Date of Tennination
(lføpplicøble)
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1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITIEE NAME OF TREASURER
Committee to Elect Marty Miller Claudette Miller
STReET ADDRESS
20348 Clay Street
STREET ADDRESS (NO P.O. BOX) - CITY STATE ZIP CODE AREA CODEIPHONE
20348 Clay Street Cupertino Ca 95014 408/750-4714
CITY STATE liP CODe AREA COOEIPHONE NAME OF ASSISTANT TREASURER, IF ANY
Cupertino Ca 95014 408/750-4714
STReET ADDRESS
MAILING ADDRESS (IF DIFFERENT)
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAl: FAX I E-MAil ADDRESS
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE MAILING ADDRESS
Santa Clara
CITY STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
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3. Verification
I have used all reasonable diligence in preparing this statement and he !dge the information contained herein is true and complete. I certify under penally of
,.,~ -,~... ","',.. """""",, ..........." .. ~
Executed on 7 T By ¿-it; !
~ fj-::... - _ E OF TRE~ R 'STANTTREASURER
Executed on t....... By..t-v1 ~ ..:>
DATE SIGNATURE OF CONTROlLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on _ By
DATE 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 (January/05)
FPPC TolI·Free Helpline: 866/ASK·FPPC (666/275-3772)
O.NUMBER
I.
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Committee to Elect Marty Miller
4. Type of Committee Complete the applicable sections.
1 candidate or officeholder controlled, also list the elective office sought or held, and
is affiliated or check "non-partisan.
List the name 01 each controlling officeholder, candidate, or state measure proponent.
district number, il any, and the year 01 the election.
List the political party with which each officeholder or candidate
If this committee acts jointly with another controlled committee.
·
·
·
controlled committee_
list the name and identification number of the other
NAME OF CANDIDATEIOFFICEHOlDERfSTATE MEAS
III Non-Partisan
Marty Miller Cupertino City Council
o Non-Partisan
candidate election- committees only)
d
·
BANK ACCOUNT NUMBER
ZIP CODE
STATE
AREA CODElPHONE
CITY
NAME OF FINANCIAL INSTITUTION
ADDRESS
below:
in a single election. lis
Primarily formed to support or oppose specific candidates or measures
FUll TITLE (tNClU
'n______ _._._ ___ _ ____, _ _ . __ _ ____._ _,_ __ _ __ _ _.__ ___, "n~""vl~'"
¡ ¡--r
SUPPORT OPPOSE
CANDIDATE(S) NAME OR MEASURE(S)
FPPC Form 410 (January/OS}
FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772)
Statement of Organization
Recipient Committee
.D. NUMBER
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.
~ CITY Committee 0 COUNTY Committee 0 STATE Committee
4. Type of Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
the committee qualified as a
liP CODE
contributor committee.
STATE
Check box and provide the date this committee qualified as a smal
small contributor committee on January 1,2001. enter 1/1/01.
CITY
NO. AND STREET
o ----1 I
Date qualified
STREET ADDRESS
assistant treasurer and/or candidate. officeholder, or proponent certify that all of the following conditions have been met
the treasurer,
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 debts, loans received, and other obligations;
This committee does not anticipate receiving contributions or
This committee has eliminated or has no intention or ability
This committee has no surplus funds; and
Refer to
FPPC Form 410 (January/OS)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)
and by defeated candidates.
reportable transactions.
campaign funds held by elected officers who are leaving office
required by the Political Reform Act disclosing al
campaign statements
There are restrictions on the disposition of surplus
Govemment Code Section 89519.
This committee has filed al