410 Statement of Organization Recipient Committee - Termination stamped by SOS Statement of Organization Date Stamp CALIFiORNIA
Recipient Committee FQ—RM Aln
RECEIVED .. N', F1 :7r 0 vw,
Statement Type 0 initial F1 Amendment Termination—See Part 5 h the office of the Secretim Q or- tial se LMiV
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Not yet qualified or List I.D.number: List I.D.number: Of the'31,31P f vP(if0AA1
13835'70
# J. MAR 20 Zoll 144 R 3 1 2017
03 10 .12017
Date qualified as committee Date qualified as committee Date of ermination
(1fapplicable) I AUPERT INO CITY CLERK
NAMEOFCOMMMEE NAME OF TREASURER
David Fung for City Council 2016 Kathy Jacques
STREET ADDRESS(NO P.C.BOX)
MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O.BOX)
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
Santa Clara lCupertino, CA
STREET ADDRESS(NO P.O.BOX)
Attach additional information on appropriately labeled continuation sheets. CITY STATE ZIP CODE AREACODE/PHONE
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 underthe laws of the State
CANDIDATE,OR STATE MEASURE PROPONENT
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@Zfppc.ca.gov(866/275-3772)
www.fppc.ca.gov