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460 Recipient Committee Campaign Statement 7-1-14 to 12-31-14Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200 - 84216.5) SEE INSTRUCTIONS ON REVERSE fro Type or print in ink. Statement covers period Date of election if applicable: m July 1, 2014 (Month, Day, Year) through December 31, 2014 1. Type of Recipient Committee: All committees - Complete Pans 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee 0 Recall Q Controlled (Also comptetal>ad5) O Sponsored ❑ General Purpose Committee (Also compJetePaa5) Q Sponsored ❑ Primarily Formed Candidate! Q Small Contributor Committee Officeholder Committee Q Political PartylCentral Committee (Also Complete Part 7) 3. Committee Information t_D. NUMBER 1287471 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) CONCERNED CITIZENS OF CUPERTINO STREET ADDRESS (NO P.C. BOX) MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX ! E -MAIL ADDRESS 2. Type of COVER PAGE Date Stamp Date Received n n I Page 1 of 4 A N 3 0 201 For Official Use Only Processed by ❑ Preelection Statement ® Semi - annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement - Attach Form 495 NAME OF TREASURER Marolyn O. Chow MAILING ADDRESS NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX ! E -MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my k d ledge the information contal h rein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and corfect� , /! l/ January 30, 2015 Executed on By LUW Dale Sig OfTreasurerorAssisfart Treasurer Executed on sY Data Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officeraf Sponsor Executed an BY Pate Signature ofControllingOfriceholder, Candidate. State Measure Proponent Executed on BY Date Signature ofControlling UKeholder, Candidate, State Measure Proponent FPPC Form 460 {Januaryl05} FPPC Toll -Free Helpline: 8661ASK -FPPC (8661275 -3772) State of California Campaign Disclosure Statement Type or print in ink. SUMMARYPAGE Summary Page Amounts may be rounded Statement covers period . to whole dollars. � , from July 1, 2014 • - • SEE INSTRUCTIONS ON REVERSE through December 31, 2014 Page 2 of 4 NAME OF FILER CONCERNED CITIZENS OF CUPERTINO LD. .D. BER NUM NUM 1287471 Contributions Received Column A Column B Calendar Year Summary for Candidates TOTALTHIS PERIOD (FROMATTACHED SCHEDULES) CALENDAR YEAR TOTALTCDATE Running in Both the State Primary and 1. Monetary Contributions ............ ............................... Schedule A, Line 3 $ 4,000 $ 4,000 General Elections 2. Loans Received ....... ............................... . .. ... .... ...... Schedule B, Line 3 111 through 6130 711 to Date 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 4,000 $ 4,000 20. Contributions 4. Nonmonetary Contributions ..... ............................... schedule c, Line 3 Received $ $ 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 +4 $ 4,000 $ 4,000 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made.. .......................... ................. ........ Schedule E, Line 4 $ 309 $ 309 Candidates 7. Loans Made .............................. ............................... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .............. . . .. .. ............ Add $ 309 $ 309 22. Cumulative Expenditures Made* (if Subject W Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ............................... schedule F, Line 3 10. Nonmonetary Adjustment ........... ............................... Schedule C, Line 3 Date of Election Total to Date (mmlddlyy) 11. TOTAL EXPENDITURES MADE ... ....................... ...... Add Lines 8 +9 +10 $ 309 $ 309 $ Current Cash Statement $ 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 470.51 To calculate Column B, add 13. Cash Receipts .......... .............. Column A, Line 3above 4,000.00 amounts in Column A to the 14, Miscellaneous Increases to Cash ........................... schedule !, Line 4 corresponding amounts from Column B of your last *Amounts in this section may be different from amounts . ................. 15. Cash Payments .................. ...... A, fine 8 above 309.00 report. Some amounts in reported in Column B. Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 4161.51 figures that should be If this is a termination statement, Line 16 must be zero. subtracted from previous period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from tines 2, 7, and 9 (if 18. Cash Equivalents ......... ............................... see instructions on reverse $ 4161.51 any). 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ FPPC Form 460 (January/05) FPPC Tol[ -Free Helpline: 8661ASK -FPPC (8661275 -3772) Schedule A Type or print in ink. SCHEDULE A to whole dollars. Monetary Contributions Received Amounts may rounded Statement covers period from JuiY 1 2014 . SEE INSTRUCTIONS ON REVERSE NAME OF FILER CONCERNED CITIZENS OF CUPERTINO DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER RECEIVED (IF COMMITTEE, ALSO ENTER IA. NUMBER) CODE * OCCUPATION AND EMPLOYER (IF SELF - EMPLOYED, ENTER NAME OF BUSINESS) Cupertino Against Rezoning ❑IND 1213114 PO Box 1466 OcoM Cupertino, CA 95015-1466 ❑OTH F] PTY ❑ SCC ❑IND ❑COM ❑ OTH ❑ PTY ❑SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ 5CC ❑IND ElCOM ❑ OTH ❑ PTY ❑5CC ❑IND ❑COM ❑ OTH ❑ PTY ❑SCC SUBTOTAL$ Schedule A Summary 1. Amount received this period — itemized monetary contributions. (include all Schedule A subtotals.) ......................................................................... ............................... $ 2. Amount received this period — unitemized monetary contributions of less than $100 ............................. $ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $ through December 31, 2014 7Pa 9 e 3 AMOUNT RECEIVED THIS PERIOD 4,000.00 4,000.00 4,000.000 FPPC Form 460 (.lanuary105) FPPC Toll -Free Helpline: 8661ASK -FPPC (8561275.3772) I.D. NUMBER 1287471 of 4 CUMULATIVE TO DATE PER ELECTION CALENDAR YEAR TO DATE (JAN. 4 - DEC. 31) (IF REQUIRED) 4,000.00 'Contributor Codes IND— Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Politica I Party SCC — Small Contributor Committee Schedule E Type or print in ink. Payments Made Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE NAML OF FILEK CONCERNED CITIZENS OF CUPERTINO Statement covers period from July 1, 2014 through December 31, 2014 page — I.D. MIME 1287471 of 4 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. GbP CMS campaign paraphernalialmisc. MBR member communications RAD radio airtime and production costs CTB campaign consultants MTG meetings and appearances RI=D returned contributions CVC contribution (explain nonmonetary)• civic donations OFC office expenses SAL campaign workers' salaries FIL candidate filing /ballot Rees PET PHO petition circulating phone banks TEL TRC t.v. or cable airtime and production costs FND fundraising events POL polling and survey research TRS candidate travel, lodging, and meals staff /spouse travel, lodging, and meals IND independent expenditure supporting /opposing others (explain)' POS postage, delivery and messenger services TSF transfer between committees of the same candidatelsponsor LEG LIT legal defense PRO professional services (legal, accounting) VOT voter registration campaign literature and mailings PRT print ads VVEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (F COMMRTEE, ALSO ENTER l,U, NUMBER} City of Cupertino CODE OR DESCRIPTION OF PAYMENT Fees paid to City of Cupertino for filing of motion for reconsideration * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) .......................................... ............................... 2. Unitemized payments made this period of under $100 ...................................................................... ............................... 3. Total interest paid this period on loans. (Enter amount from Schedule S, Part 1, Column (e).) ........... ............................... 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) SUBTOTAL$ .... ...I ........................... $ .... ............................... $ .... ............................... $ TOTAL $ AMOUNT PAID $299.00 299.00 299.00 FPPC Form 460 (January105) FPPC Toll -Free Helpline: 8661ASK -FPPC (8681275 -3772)