450 Recipient Committee Campaign Statement 1/1/16 - 6/30/16 Recipient Committee
Campaign Statement- Short Form
SEE INSTRUCTIONS ON REVERSE
Statement covers period
For use by recipient committees that have not received a from January 1, 2016
contribution or other receipt that must be itemized, have not
received or made loans, and have no outstanding accrued
ex June 30, 2016
P e through
1. Type of Recipient Committee:
❑ Ballot Measure Committee ® General Purpose Committee
0 Primarily Formed 0 Sponsored
0 Controlled 0 Small Contributor Committee
0 Sponsored
❑ Primarily Formed Candidate/
Officeholder Committee
3. Committee Information I D NUMBER
1287471
COMMITTEE NAME
CONCERNED CITIZENS OF CUPERTINO
STREETADDRESS(NO P.O.BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
CUPERTINO CA 95014
MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O.BOX
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX/E-MAIL ADDRESS
Date of election if appli
(Month, Day,Year)
J U L - 1 2016
SHORTFORM
1 of 3
Official Use Only
PUPERTINO CITY CLERK 1
2. Type of Statement:
❑ Pre-election Statement ❑ Quarterly Statement
® Semi-annual Statement ❑ Special Odd-year Report
❑ Termination Statement
❑ Amendment (Explain)
(Also check type of statement you are amending)
Treasurer(s)
NAME OF TREASURER
MAROLYN O. CHOW
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
CUPERTINO CA 95014
NAME OF ASSISTANT TREASURER,IF ANY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX/E-MAIL ADDRESS
4.Verification
I have used all reasonable diligence in preparing and reviewing this statement
contained herein is true and complete. I certify
TREASURER
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,STATE MEASURE PROPONENT,OR RESPONSIBLE OFFICER OF SPONSOR
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,STATE MEASURE PROPONENT
Executed on _ By
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,STATE MEASURE PROPONENT
FPPC Form 450(Jan/2016)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fDoc.ca.eov
Recipient Committee Amounts may be rounded SHORT FORM
Campaign Statement
to whole dollars. Statement covers period 0 .
Summary Page from January 1, 2016
through June 30, 2016 page 2 of 3
NAME OF COMMITTEE
CONCERNED CITIZENS OF CUPERTINO
1 1287471
I
Expenditures Made
1. Expenditures of$100 or more made this period.......................................................................................................
...............................
$
1,000
2. Expenditures under$100 made this period (Not itemized.)......................................................................................
...............................
3. SUBTOTAL EXPENDITURES MADE THIS PERIOD...............................................................................
...............................Add Lines 1 + 2
$
1,000
4. Nonmonetary Adjustment............................................................................................................
............................... From Line 8 Below
5. Total expenditures made from previous statement................................................
(If this is the first statement for the calendar year, enter zero.)
...............................Previous Summary Page, Line 6
$
1,000
6. TOTAL EXPENDITURES MADE TO DATE......................................................................................
...............................Add Lines 3 +4 +5
$
Contributions Received
7. Monetary contributions received this period..............................................................................................................
...............................
$
8. Non-monetary contributions received this period......................................................................................................
...............................
9. Total contributions received from previous statement..........................................
...............................Previous Summary Page, Line 10
$
(If this is the first statement for the calendar year, enter zero.)
10.TOTAL CONTRIBUTIONS RECEIVED TO DATE.............................................................................
...............................Add Lines 7+ 8+ 9
$
Current Cash Statement
11. Beginning cash balance................................................................
......................................................Previous Summary Page, Line 15
$
3,211.51
12.Cash receipts this period.......................................................................................................................
...............................Line 7 above
0
13.Miscellaneous increases to cash..............................................................................................................................
...............................
$
14.Cash expenditures this period.........................................................................
.....................................................................Line 3 above
1.000
15.ENDING CASH BALANCE THIS PERIOD ...............................................
............................Add Lines 11 + 12+ 13, then subtract Line 14
$
2,211.51
FPPC Form 450(Jan/2016)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Recipient Committee Amounts may be rounded
Campaign Statement— Short Form to whole dollars.
from
Statement covers period
January 1, 2016
SEE INSTRUCTIONS ON REVERSE through June 30, 2016 page 3 of 3
NAME OF COMMITTEE
I.D.NUMBER
CONCERNED CITIZENS OF CUPERTINO 1287471
5. Payments Made (if more space is needed,use additional copies of this page for continuation sheets.)
DATE*
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE,ALSO ENTER LID.NUMBER)
DESCRIPTION OF PAYMENT
NAME OF CANDIDATEAND OFFICE OR
NAME OF BALLOT MEASURE AND
BALLOT NUMBER OR LETTER
AND JURISDICTION
AMOUNT
THIS PERIOD
CUMULATIVE
AMOUNTS TO DATE*
COMMITTEE SUPPORTING CUPERTINO
CONTRIBUTION
Calendar Year
1/9/2016
CITIZENS SENSIBLE GROWTH INITIATIVE
FPPC#: 1381645
PO Box 1132
Cupertino, CA 95015.1132
1,000
1,000
$
Other
® Support ❑ Oppose
$
® Contribution ❑ Ind. Exp.
Calendar Year
$
Other
❑ Support ❑ Oppose
❑ Contribution ❑ Ind. Exp.
$
Calendar Year
$
Other
❑ Support ❑ Oppose
❑ Contribution ❑ Ind. Exp.
$
SUBTOTAL $ 1,000
*Required only for payments which are contributions or independent expenditures.
FPPC Form 450(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
wwwJppc.ca.gov