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410 Statement of Organization Recipient Committee – Initial – Stamped by SOS 7C-6717 ( -Statement of Organization l C71 Date Stamp CALIFORNIA 410 Recipient Committee1 FORM \tatementType ®Initial (.30 Amendment 0 Termination—See Part 5 RECEIVED AND FIE F .nm" III° n Iv List I.D.number: List I.D.number: in the office of the Secretary of .'F L © IA U 't// SSL - Notyetquatified 21 or of the Slate of California U v L5 " " MAR 04 2016 MAR 2 52016 si Date qualified as committee Date qualified as committee Date of Termination (II ppll ble) IffCommittiatifor, '' _ 0 _ 2 'ipeasUferaagdtOthe?:PGtncipaf OHfieralte, ' it iIIUU'C 1!i X` Lk ' matlbPl .,.',�'? i,'71.;� cx kl ;x# .y„ .,. F.&..-3xa. NAME OF COMMITTEE NAME OF TREASURER J David Fung for City Council 2016 Kathy Jacques STREET ADDRESS(NO P.O.BOX) STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O.BOX) FAX/EMAIL ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S) Cupertino, CA STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. 1u@RIgItaffry � .", u.u- a`LFDT ,.1:;.:,."4" xfis flv-Rx1,m"u2/.4 iti o s§ .'i xA/';r: pYtek :} Y Tr±, `YViai! a ft; .6ix 8it tf., . F. ,,-;,.;1 , I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of Californ)a teat Vii=oregoing is true and correct. Executed on 02/29/2016 By 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(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov (ttatement of Organization CALIFORNIA 41 0 Recipient Committee FORM \INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D.NUMBER David Fung for City Council 2016 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER Pending ID # ADDRESS CITY STATE ZIP CODE y� / TYReOfaO _Ie Om• teffitGCt"1$ �>'er W£9r 8.�� P s n s' Zeit Tyll;1.1u..u,afy „$ [� Effolliil Gom in rtte e • List the name of each controlling officeholder,candidate,or state measure proponent. If candidate or officeholder controlled,also list the elective office sought or held,and district number,if any,and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check"nonpartisan." • If this committee acts jointly with another controlled committee,list the name and identification number of the other controlled committee. ELECTIVE OFFICE SOUGHT OR HELD NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY ® Nonpartisan David Fung Cupertino City Council 2016 O Nonpartisan Amarly Formed committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATES)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTER) (INCLUDE DISTRICT NO.,CITY OR COUNTY AS APPLICABLE) CHECK ONE SUPPORT OPPOSE ❑ n SUPPORT OPPOSE ❑ ❑ FPPC Form 410(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov