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460 Recipient Committee Campaign Statement – Preelection Statement COVER PAGE Recipient Committee t � �i , � . , � t Campaign Statement . - • Cover Page rl S E P 2 9 2016 " e�_ of�_ Statement covers period Date of election if applicab e: 7/1/2016 (Month,Day,Year) For Official Use Only from PERTINO CIN CLLRd� SEE INSTRUCTIONS ON REVERSE thr'oUgh 9�24/2016 November 8, 2016 1. Type of Recipient Committee: Au comm�ctees-comPiete Pans�,2,3,a�a a. 2. Type of Statement: ��, � Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure � Preelection Statement � (�uarterly Statement � State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report � Recall 0 Controlled ❑ Termination Statement (AlsoCompletePaRS) � Sponsored (Also file a Form 410 Termination) (Also Complete Part 6) ❑ General Purpose Committee ❑ Amendment(Explain below) � Sponsored ❑ Primarily Formed Candidate/ � Small Contributor Committee Officeholder Committee � Political Party/Central Committee (Also Complete PaR 7) 3. Committee Information I '.o."uMBER Treasurer(s) 1386578 COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Jerry Liu for City Council 2016 Jennifer Fang MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE 21837 Lomita Avenue CITY STATE ZIP CODE NAME OF ASSISTANT TREASURER,IF ANY Cupertino CA 95014 865-377-9548 Nan Yu MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O.BOX CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS 2016@jerryliu.com , 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein 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 Treasurer Executed on September 28, 2016 By � t4 Date Signature of Conlrolling�ceholder,Candidate,State Measure Proponent or Responsible Officer of Sponsor Executed or BY ' Date SignaWre of Controlling Officeholder,Candidate,State Measure Proponent Executed on BY Date Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) COVER PAGE-PART 2 Recipient Committee • - � , Campaign Statement • � � � Cover Page — Part 2 Page 2 of !( 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Jerry Liu OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER I JURISDICTION I � SUPPORT Cupertino City Councilmember ❑ OPPOSE RESIDENTIAL/BUSINESSADDRESS (NO.ANDSTREET) CITY STATE ZIP Identify the controlling officeholder,candidate,or state measure proponent,if any. 21837 Lomita Avenue Cupertino CA 95014 � NAME OF OFFICEHOLDER,CANDIDATE,OR PROPONENT Related Committees Not Included in this Statement: ��stanycomm�rrees not included in this statement that are controlled by you or are primarily formed to receive OFFICE SOUGHT OR HELD I DISTRICT NO.IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D.NUMBER CONTROLLED COMMITTEE? 7• PCII'T18CII�/ FOI'lll@CI C811CIICIat@IOffIC@IIOIC�@I'C01111111tt@e Listnames of NAME OF TREASURER officeholder(s)or candidate(s)for which this committee is primarily formed. ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE COMMITTEE NAME I.D.NUMBER � NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ YES ❑ NO ❑ OPPOSE COMMITTEEADDRESS STREETADDRESS (NO P.O.BOX) � CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460(1an/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded SUMMARY PAGE to whole dollars. Statement covers period � - Summary Page 7/1/2016 . - ' • � from through 9�24/2016 page 3 of �� SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Jerry Liu for City Council 2016 1386578 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDARYEAR (FROMATTACHEDSCHEDULES) TOTALTODATE Running in Both the State Primary and 2900.00 10474.00 General Elections 1. Monetary Contributions................................................... scneduiea,une s $ $ 1/1 through 6/30 7/1 to Date 2. Loans Received................................................................ scneduie e,�ine s 0.00 15000.00 2900.00 25474.00 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS.............................. Add�ines 1+2 $ $ Received $ $ 424.99 424.99 4. Nonmonetary Contributions............................................ scneduie c,�i�e s 21. Expenditures 3324.99 25898.99 Made $ $ 5. TOTAL CONTRIBUTIONS RECEIVED....................................Add�ines 3+4 $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made................................................................ scneduie E,�ine a $ 10498.63 $ 10720.38 Candidates 7. L08f1S Mad@....................................................................... Schedule H,Line 3 0.00 0.00 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS.......................................... Add�ines s+7 $ 10498.63 $ 10720.38 (If Subjec[to Voluntary Expenditure Limit) 9. Accrued Expenses(Unpaid Bills)..........................................scneduie F une s 0.00 0.00 Date of Election Total to Date 10. Nonmonetary Adjustment.........................................................scneduie C,Line 3 0.00 0.00 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE........................................Add�ines 8+s+�o $ 10498.63 $ 10720.38 _�_� $ Current Cash Statement �� $ . 22574.00 12. Be9illfllllg CaSh B81811C2............................ Previous Summary Page,Line 16 $ To calculate Column B, 13. Cash ReCelpts........................................................... Column A,Line 3 above 2900.00 add amounts in Column 0.00 A to the corresponding *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash.................................. scneduie i,�rne a amounts from Column B reported in Column B. 10498.63 of your last report. Some 15. Cash Payments......................................................... Co�umn,4,�ine s above amounts in Column A may 16. ENDING CASH BALANCE ..................Add�ines�2+�s+14,then subtract Line 15 $ 14975.37 be negative figures that should be subtracted from If this is a termination statement, Line 16 must be zero. previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED................................ Schedule e,Part 2 $ 0.00 fifed for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2,�,and 9(if 18. CBSh EqUiv8lentS................................................ See instructions on reverse $ 0.00 any). 19. OUtStallding Debts.............................. Add Line 2+Line 9 in Column e above $ 15000.00 FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A Monetary Contributions Received towholedollars. Statementcoversperiod • - � • 1 from ��1/2016 � _ SEE INSTRUCTIONS ON REVERSE through 9�24/2016 Page ` of /� NAME OF FILER I.D.NUMBER Jerry Liu for City Council 2016 1386578 DATE FULL NAME,STREETADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS RECEIVED CODE �` (IF SELF-EMPLOYED,ENTER NAME PERIOD (AN ND DEC 81) (IF REQUIRED) OF BUSINESS) Alviar Wallis �IND i 8/16/2016 � ❑PTY ❑scc Xiaodi Cui �IND 8/16/2016 ❑PTY ❑scc �IND Xiangchen Xu ❑conn En ineer 8/16/2016 ❑PTY ❑scc CC Yin �IND 7/7/2016 ❑PTY ❑scc Bob Adams �IND 8/16/2016 ❑PTY Planning ❑scc SUBTOTAL$ 1200.00 � Schedule A Summary � �ContributorCodes 1. Amount received this period - itemized monetary contributions. irv�-individuai (Include all Schedule A subtotals.) $ 2800.00 COM—Recipient Committee ......................................................................................................... (other than PTY or SCC) 2. Amount received this period - unitemized monetary contributions of less than $100 ...........................$ 100.00 OTH—Other(e.g., business entity) PTY—Political Party 3. Total monetary contributions received this period. scc-smau cor,trib�tor comm�ttee (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................TOTAL $ 2900.00 - FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULEA (CONT.) Monetary Contributions Received to whole dollars. Statement covers period , � _ � from 7/1/2016 • ' � t through 9�24/2016 Page S of 1� NAME OF FILER I.D.NUMBER Jerry Liu for City Council 2016 1386578 DATE FULL NAME,STREETADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR �F AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC.31) (IF REQUIRED) OF BUSINESS) �IND Researcher ❑OTH University of Chicago 100.00 100.00 100.00 Cupertino, CA 95014 ❑PTY ❑scc ❑OTH 300.00 300.00 300.00 Cupertino, CA 95014 ❑PTY ❑scc ❑coM Apple 250.00 250.00 250.00 ❑OTH Cupertino, CA 95014 ❑PTY ❑scc ❑OTH �NaveZero 150.00 150.00 Cupertino, CA 95014 ❑PTY ❑scc ❑OTH 300.00 300.00 300.00 Berwyn, PA 19312 ❑PTY ❑scc SUBTOTAL$ 1100.00 I , � `Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) OTH—Other(e.g.,business entity) PTY—Political Party FPPC Form 460(Jan/2016) SCC—Small Contributor Committee FPPC Advice:advice@fppc.ca.gov(866/275-3772) � � www.fppc.ca.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULEA (CONT.) Monetary Contributions Received to whole dollars. Statement covers period � _ , I ' from 7/1/2016 � ' � Jerry Liu for City Counci12016 through 9�24/2016 page � of � � NAME OF FILER I.D.NUMBER CONTRIBUTOR IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FULL NAME,STREETADDRESS AND ZIP CODE OF CONTRIBUTOR * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE,ALSO ENTER I D.NUMBER) CODE QF SELF-EMPLOYED,ENTER NAME OF BUSINESS) PERIOD (JAN.1-DEC.31) (IF REQUIRED) �OTH 500.00 500.00 500.00 San Jose, CA 95196 ❑PTY ❑scc ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC SUBTOTAL$ 500.00 I I 'Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) OTH—Other(e.g.,business entity) PTY—Political Party SCC—Small Contributor Committee FPPC Form 460(Jan/2016) , FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Amounts may be rounded SCHEDULE B-PART 1 Schedule B — Part 1 to whole dollars. Statement covers period � _ ' Loans Received � � from ��1�2016 � - SEE INSTRUCTIONS ON REVERSE through 9�24/2016 page� of �/ NAME OF FILER I.D.NUMBER Jerry Liu for City Council 2016 1386578 IF AN INDIVIDUAL,ENTER �a� (b) (c) ldl �e� �t� �g) � FULL NAME,STREETADDRESSAND ZIP CODE OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OF LENDER OCCUPE�FOMA oD�EMPTOYER gALANCE RECEIVED THIS OR FORGIVEN BALANCE AT pAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE,ALSO ENTER I.D.NUMBER) NAME OF BUSINESS) BEGINNING THIS pERIOD THIS PERIOD" CLOSE OF THIS pERIOD LOAN TO DATE PERIOD PERIOD Jerry Liu Research Manager ❑ PAID CALENDAR YEAR 21837 Lomita Avenue HP Inc � 0 $ 15000 , � 15000 $ 15000 Cupertino, CA 95014 ❑ FORGIVEN RATE pER ELECTION`� � 15000 � 0 � 0 12/31/20 § 6/29/16 s 15000 t Q IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR � $ % S 5 RATE ❑ FORGIVEN PER ELECTION" $ $ $ $ $ t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR $ S % $ $ RATE ❑ FORGIVEN PER ELECTION" $ $ $ $ $ f❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ 0 $ 0 $ 15000 $ I (Enter(e)on Schedule B Summary Schedule E,Line 3) 1. Loans received this period....................................................................................................................$ � (Total Column (b) plus unitemized loans of less than $100.) tcontributor Coaes � 2. Loans aid or for iven this eriod.........................................................................................................$ IND—Individual p 9� P n COM—Recipient Committee (Total Column (c) plus loans under$100 paid or forgiven.) (other than PTY or SCC) (Include loans paid by a third party that are also itemized on Schedule A.) OTH—Other(e.g.,business entity) PTY—Political Party 3. Net chan e this eriod. Subtract Line 2 from Line 1. NET $ n SCC—Small Contributor Committee 9 p � ) .............................................................. . , Enter the net here and on the Summary Page, Column A, LII�e 2. (Maybeanegativenumber) � Amounts forgiven or paid by another party also must be reported on Schedule A. FPPC Form 460(Jan/2016) `"If required. FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule C Amounts may be rounded SCHEDULE C to whole dollars. Nonmonetary Contributions Received statementcovers period � _ ' � � from 7/1/2016 • " through 9�24/2016 page � of �l SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Jerry Liu for City Council 2016 1386578 � IFAN INDIVIDUAL,ENTER AMOUNT/ CUMULATIVE TO pER ELECTION DATE FULL NAME,STREETADDRESSAND CONTRIBUTOR DESCRIPTION OF DATE RECEIVED ZIP CODE OF CONTRIBUTOR CODE* OCCUPATION AND EMPLOYER GOODS OR SERVICES FAIR MARKET CALENDAR YEAR TO DATE (IF COMMITTEE,ALSO ENTER I.D.NUMBER) (IF NAME OF BUSINESS)TER VALUE ( ) (IF REQUIRED) JAN 1-DEC 31 [�oTH 274.99 274.99 274.99 Cupertino CA 95014 ❑PTY ❑scc 8/16/2016 ❑oTH Samsung beverages for 150.00 250.00 Mountain View, CA 94043 ❑PTY kickoff ❑scc ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL$ 424.99 I I Schedule C Summary ' �Contributor Codes ` 1. Amount received this period - itemized nonmonetary contributions. iN�-ind���dUai (Include all Schedule C subtotals.)......................................................................................................................$ 424.99 COM—Recipient Committee (other than PTY or SCC) 2. Amount received this period -unitemized nonmonetary contributions of less than $100 ..................................$ O OTH—Other(e.g.,business entity) PTY—Political Party 3. Total nonmonetary contributions received this period. scc-smau contributor committee (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.).....................TOTAL $ 424.99 � FPPC Form 460(1an/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov SChedule D SCHEDULE D Summary of Expenditures Amounts may be rounded Statement covers period � _ SU OI"tltl �� OSI�I Other towholedollars. ' . _ � I � ' pp 9 pp g 7/1/2016 Candidates, Measures and Committees from through 9�24/2016 Page I of �� SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Jerry Liu for City Council 2016 1386578 � CUMULATIVE TO DATE PER ELECTION DATE NAME OF CANDIDATE,OFFICE,AND DISTRICT,OR TYPE OF PAYMENT DESCRIPTION AMOUNT THIS CALENDAR YEAR TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) PERIOD (JAN.1-DEC.3t) (IF RE4UIRED) OR COMMITTEE Santa Clara County UDC � Monetary 9/22/2016 Contribution ❑ Nonmonetary San Jose, CA. 95128. contribution ❑ Independent � Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution � Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ 1500.00 I Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.)....................................................... $ 1500.00 2. Unitemized contributions and independent expenditures made this period of under$100.................................................................................... $ 0.00 3. Total contributions and inde endent ex enditures made this eriod. Add Lines 1 and 2. Do not enter on the Summar Pa e. TOTAL.. $ 1500.00 P p P � Y 9 ).......... FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov SCHEDULE E Schedule E Amounts may be rounded Statement covers period � - to whole dollars. � � ' Payments Made from ��1/2016 • ' through 9�24/2016 Page /� op �% SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Jerry Liu for City Council 2016 1386578 � CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution(explain nonmonetary)' OFC office expenses SAL campaign workers'salaries CVC civic donations PET petition circulating TEL t.v.or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging,and meals FND fundraising events POL polling and survey research TRS 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 candidate/sponsor LEG legal defense PRO professional services(legal,accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs(internet,e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID LIT 4493.54 San Jose, CA 95110 City of Cupertino 10300 Torre Avenue FIL 1920.00 Cupertino, CA 95014 CMP 940.00 Glenside, PA 19038 *Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 7353.54 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.)............................................................................................................. $ 10468.63 30.00 2. Unitemized payments made this period of under$100.......................................................................................................................................... $ 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).)............................................................................. $ 0.00 4. Total a ments made this eriod. Add Lines 1, 2, and 3. Enter here and on the Summa Pa e, Column A, Line 6. TOTAL $ 10498.63 p Y p � rY 9 )........................... FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule E Amounts may be rounded SCHEDULE E(CONT.) (Continuation Sheet) to whole dollars. Statement covers period •� _ I • t Payments Made from 7/1/2016 through 9�24/2016 Page � � of �� SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Jerry Liu for City Council 2016 1386578 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution(explain nonmonetary)" OFC office expenses SAL campaign workers'salaries CVC civic donations PET petition circulating TEL t.v.or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging,and meals FND fundraising events POL polling and survey research TRS 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 candidate/sponsor LEG legal defense PRO professional services(legal,accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs(internet,e-mail) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE,ALSO ENTER I.D.NUMBER) WEB 1000.00 Washington, DC 20005 CMP 195.75 San Jose, CA 95125 POS 280.00 San Jose, California 95125 OFC 139.34 Seattle, WA, 98109-5210 CTB 1500.00 San Jose, CA. 95128 *Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 3115.09 FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) .........F.....��-. ......