450 Recipient Commitee Short Form 01-01-13 thru 06-30-13Recipient Committee
Campaign Statement i Shoat Form
SEE INSTRUCTIONS ON REVERSE
For use by recipient committees that have not received
cont6bution or other receipt that must be itemized, have not
received or made loans, and have no outstanding accrued
expenses.
Type or print in ink.
Statement corners period
from January 1, 2013
through ,dune 3, 2013
1. Type of Red plent Comrnitt e:
❑ Ballot Measure Committee General Purpose Committee
Primarily Formed 0 Sponsored
Controlled Small Contributor Commidee
Sponsored
r-1 Primarily Formed Candidate/
Officeholder Committee
3. Committee of rmati n I.D. NUMBER
COMMITTEE NAME
CONCERNED CITIZENS OF CUPERTINO
STREET ADDRESS (NO P.O. BCC )
4 AIUN ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
01
Date of election if appli I :
(Montt, Day, Year
JUL 3 12013
ERTINO CITY CL
2. Type of Statement:
❑ re- election Statement
Semi-annual Statement
E] Termination Statement
SHORT F RM
C-4LIFORNIA .0
•
fi
p � of
r Official Use Only
L Fo y
7� 71
El Quarterly Statement
El Special Odd- year Deport
E] Supplemental Pre - election
Statement - Attach Foy 495
D Amendment (Explain) .., -
Also check type of statement you are amending)
Treasurer(s)
NAME OF TREASURER
URER
ar lyn 0. Chow
MAILING ADDRESS
NAME OF ASSISTANT TREASURER, ER, IF ANY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE]PHONE CITY STATE ZIP CODE AREA D DEPH NE
OPTIONAL.: FAX I E-MAIL ADDRESS OPTIMAL FAX I E-MAIL AMRESS
4. Verification
ati
I have used all reasonable diligence in preparing and reviewing this statement - the besFof y k no the information contained herein x true and complete. I certify J* � t+ under penalty of perjury under the laves of th State of California that the fore vlr� true and ect.
Executed on July , 2013
}ATE 61GNATURE 01= TREASURER OR ASS ISTANTTREASUREF
Executed on B
DATE SI NATURE OF CONTROLLI M FFI EH0LDER, CANDIDATE, STATE MEASURE PROPONENT, OR R ESPONS ISLE OFFICER OF SPONSOR
Executed on By
DATE SIGNATURE OF CONTROLLING OFRCEHOLDER, CAN DI DATE, STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF cOt TROLLI NG OFFICEHOLDER, CAN DIDATE, STATE MEASURE PROPONENT
FPPC Foci 460 (January/
FPPC Toll -Free Helpfi ne: S 1A K-FPP (8661275--2772)
Recipient Committee
Campaign Statement
Summary Page
Type or print In ink.
Amounts may be rounded
to whole dollars.
Expenditures Made
I. Expenditures of $100 or more made this period ......... ........ .... a...........+...,.......,._+.++. a....... ............. ...................................................
,....,..
2. Expenditures under $100 made this period (Not itemized.) ......................... ,. a..,._.........._......,. ... ,...... .,.,.., a+........,..... ....................a..........
SHORT FORM
220,00
•i t1
3. SUBTOTAL EXPENDITURES MADE THIS PERIOD ............ ..a._._............................................... .. ........................ I ............. ,............... Add Lines I +
4. Nonmonetary Adjustment + ............... a....._._.... a......_.,..+. a.. a............. a....__..,. a.........,.....,. a._._.....+.
a: ,......,..,..a.....,......,..,. From Line 8 Below
6. Total expenditures made from previous statement Previous Summary mary Page, Lire
(If this is the first statement for the calendar year, enter zero.)
6. TOTAL EXPENDITURES LADE To DATE .............. AddLines3+4+5
$ 20,
Contributions Receive
7. Monetary contributions received this period .,,+,...... a..,. .............. _ ................ a......._...+........_..+. a.... a. a_....... a..,....,..,,,,.. .,..,,..,,,a......,,,..,,a..._,
8. Non-monetary contribution received this period ,....+.. a.......,.. t.aa.._..,.,. a:.aa._.., rt. r....ka ........ ......
a4..., .......... __ ......... .+.,. .a..a.._._ „a,.....,._......aa..
9. Total contributions received from previous statement ..,...+.. a....... r,.aa. a.... a..... a..,.+..,. .....,..a...,....a_,.......Previous Summary Page, Line
(if this is the first statement for the calendar year, enter zero.)
10. TOTAL CO T IBUTI S RECEIVED TO DATE ........ .................................................. ...................................
... ..................... _.. Add Lines 7 + 8 +
Current Cash Statement
1. Beginning cash balance
..... Previous Summary Page, Line 9
550,51
12, Cash receipts this period ........ .. a. r ................. a.......,...,. a+. t..+...,.,..... a....,_..,.....,...._..,..,. a......,,..................
......._.._.........--- ,.,.. +.. Line 7 above
13. Misoellaneo s increases to Cash a.._-_... a ............... a... a....._..., a.. a,...._...... a... k+.,.. a..... a...,.,,.,,.
a. a..._....,.,.+..+_.... a_..,. a...-___.. ,....a..._,..a +. +..........,. +.
14. Cash expenditures this period .,.... a.,_,....__ ....... _ ...................... ..,_..,.... a....._..,.. ............ ...........
..,.... a...._ ............_............._.... Line 3 above
15- ENDING CASH BALANCE THIS PERIOD ............................................................ .. +....
Add Lines 11 + 9 + 13., then subtract Line 1
425.51
FPPC Form 450 Wanuary/ }
FPPC Toil -Free Helpflne 61A K +PPC (8661275-3772)