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410 Statement of Organization Recipient Committee - Termination Statement of Organization Recipient Committee Statement Type ❑Initial Not yet qualified❑ or Date as committee ❑ Amendment List I.D.number: # 1386578 Date qualified as committee (if applicable) ® Termination-See Part!; List I.D.number: # 1386578 12 31 /2016 Date of Termination f � JAN 2 1 2017 t� For Official Use Only NAME OF CO MMITTEE Jerry Liu for City Council 2016 NAME OF TREASURER -" Jennifer Fang STREET ADDRESS(NO P.O.BOX) STREETADDRESS(NO P.O.BOX) 21837 Lomita Avenue 21837 Lomita Avenue "TM STATE ZIPCODE AREA CODE/PHON E CITY Cupertino STATE ZIP CODE AREA CODE/PHONE CA 95014 NAM AS EOFSISTANT (408)996-1177 CA 95014 (408)996-1177 Nan Yu MAILING ADDRESS( STREET ADDRESS(No FAX/E-MAIL ADDRESS 1935 Cappelletti Court 20160 jerryllu.com CITY STATE ZIP CODE AREA CODE/PHONE COUNTY OF DOMICILE Santa Clara JURISDICTION WHERE COMMITTEE ISACTIVE Cupertino, View CA 94043 NAME OF PRINCIPAL 15)308-7281 CA STREET ADDRESS(NO P.O.BOX) Attach additional information on appropriately labeled continuation sheets. "TM STATE ZIP CODE I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and tom penalty of perjury under the laws of the State of California that- PROPONENT Executed on B DATE y Executed on By OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT DATE Y SIGNATURE 0.CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT AREA CODE/PHONE under FPPC Form 410(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov